Microdecompression Endoscopic (Arthroscopic) Spinal Discectomy

Table of Contents

Introduction
What is Microdecompression Endoscopic Spinal Discectomy?
Who Should Consider this Procedure?
The Procedures
Postoperative Course
Advantages
Summary

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Introduction

Back and neck pain is the price human beings pay for poor posture, prolonged sitting, lifting, repeated bending, obesity, and whip lash injury from high-speed accidents. It is providing the United States with a massive economic headache. Approximately 85% of inhabitants of the Western world are afflicted with some degree of back or neck pain at some point in their lives. About 25% of our population has been incapacitated for 2 weeks or more and possibly 8 to 10 million people have a permanent disability from it. In most cases, simple treatments such as bed rest, exercise, physiotherapy, and pain medication bring relief. But many sufferers are not so fortunate. If one or more of their vertebral disks rupture and press on nerve roots, the pain that radiates from the back or neck and down the limbs can be incapacitating and severe.

Side view of herniated disc.

Back and neck pain is the price human beings pay for poor posture, prolonged sitting, lifting, repeated bending, obesity, and whip lash injury from high-speed accidents. It is providing the United States with a massive economic headache. Approximately 85% of inhabitants of the Western world are afflicted with some degree of back or neck pain at some point in their lives. About 25% of our population has been incapacitated for 2 weeks or more and possibly 8 to 10 million people have a permanent disability from it. In most cases, simple treatments such as bed rest, exercise, physiotherapy, and pain medication bring relief. But many sufferers are not so fortunate. If one or more of their vertebral disks rupture and press on nerve roots, the pain that radiates from the back or neck and down the limbs can be incapacitating and severe.

Top view of herniaged disc.

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What is Microdecompression Endoscopic Spinal Discectomy with Laser Thermodiscoplasty?

Microdecompression Endoscopic Spinal Discectomy with Thermodiscoplasty is a new procedure for decompression of damaged spinal discs. Using the help of x-rays, fluoroscopy, and video endoscopy for magnification and guidance, through a small tube with special tiny surgical instruments, a discectome, and a laser probe are inserted into the disk and a portion of the offending disk is removed and shrunk by laser. The procedure is also sometimes used for the removal of small bony spurs.

An endoscopic probe.

This is different from standard disk surgery because there is no traumatic muscle dissection, bone removal, or bone fusion. The incision is tiny enough to close with a small bandage. Therefore, most complications that occur with conventional surgery are eliminated with this procedure.

Miniature forceps probe.

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Who Should Consider These Procedures?

Microdecompression Endoscopic Spinal Discectomy is specifically designed for patients with uncomplicated herniated disks accompanied by the following:

1. Pain of the low back, neck or limbs.
2. Pain that has not responded to conventional treatments including physical therapy, medication, exercise and rest for at least six weeks.
3. A positive CT scan, MRI scan, or myelogram for disk herniation.
4. This procedure is not designed for patients with:
5. Patients who have had a previous spinal operation for disk problems at the same level, (except in a good number of cases), without significant adhesion or scarring around the disk.
6. Patients with symptoms from advanced arthritis of the spinal joints, or large bone spurs that may cause a similar type of pain.
7. Evidence of neurological or vascular pathologies mimicking a herniated disk.
8. Evidence of advanced spondylosis (significant bony spurs) with disk space narrowing, causing spinal canal constriction, diffuse annular bulging and other spine irregularities.
9. Existence of other pathologies or conditions such as fractures, tumors, pregnancy or active infections.

Endoscopic probe with light.

Other surgical procedures, including micro-spinal surgery, are at times best used for those patients who cannot have the endoscopic procedure. Only patients with clinical abnormalities confirmed by physical examination, x-ray, MRI, or CT scans are considered for these new procedures.

Miniature cutting and grasping forceps.

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The Procedures

Depending on the type of surgery indicated, the procedure is done with the patient under either a local anesthesia (low back) or a brief general anesthesia (neck).

An endoscopic probe.

Using high-tech x-rays and video imaging for guidance, a hollow tube for using a variety of surgical instruments and the endoscope inside, is inserted into the disk space. The instruments include mini-micro forceps, currettes, cutters, and the discectome probes. The laser probe is used to shrink, to tighten and to burn away portions of a disk. The procedure takes about 40 minutes on the average. X-ray exposure is minimal.

A suction probe.

After the mechanical portion of the procedure, a hollow probe is used to suction and remove small pieces of disk material. Enough disk is removed for decompression of the nerve root before application of the laser for further decompression of the bulging disk. The supporting structure of the disk is not affected. Upon completion a small bandage is applied over the incision.

A laser PLD in action.

In the not too distant future, this endoscopic procedure will be used even for bone fusion and internal fixation/stabilization.

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Postoperative Course

The patient may feel relief from pain immediately following this outpatient procedure. Some patients experience mild muscle spasms that can generally be relieved with muscle relaxants and analgesics. Pain in the area of the operation is usually minimal and requires no medication. Walking and exercising are usually encouraged on the day of discharge, and a daily exercise program is recommended. There is a re-evaluation several days later. Little, if any, postoperative medication is required for most patients and normal activities can usually be resumed at the doctor's discretion within a few days to a few weeks.

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Advantages

The primary advantage of this procedure is that there is no interference with the muscles, bones, joints or manipulation of the nerves in the spinal area. Since it is an outpatient procedure there is no hospitalization required. It is less traumatic both physically and psychologically. It is done under local or brief general anesthesia, which reduces risk. Because insertion of the tiny arthroscope through the muscle is the only wound, there is no scarring in or around the nerves postoperatively. The patient can begin an exercise program on the day of the procedure. The cost of surgery is approximately 40% less than conventional spinal surgery. The economic savings for the employee and employer are significant due to less time lost during recovery. However, the laser can further shrink and tighten the disk bulge for disk decompression.

At times, patients who have free fragments of disk in the spinal canal, as determined by an MRI scan, may also benefit from this arthroscopic procedure. It is essential to understand that not all patients are relieved of their pain with this procedure. Approximately 90 percent of patients have experienced pain relief. Patients who do not obtain relief within three to six weeks may be considered for micro-laminectomy surgical disk removal, depending on the circumstances. There does not appear to be any detrimental effect from performing Microdecompression Endoscopic Spinal Discectomy before the open micro-surgical procedure.

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Summary

Results with Microdecompression Endoscopic Spinal Discectomy with Laser Thermodiskoplasty (a minimally invasive spine surgery) indicate no hospitalization requirement, earlier return to work and earlier return to previous daily activities. Rare patient complications include mild muscle spasms and transient pain. Patients who initially have obtained good results appear to remain pain free.

Contents courtesy California Center for Minimally Invasive Spine Surgery
Used by permission