Endoscopic Discectomy
WHAT IS IT?
Endoscopic microdiscectomy, also known as endoscopic microdecompression surgery, is an ultraminimally invasive procedure that can be used throughout the entire spine to treat herniated disc. Using a specialized endoscope, the decompression surgery is performed under water with the use of endoscopic tools to remove the herniated disk that is impinging on spinal nerve roots and or the spinal cord.
HOW IS THE PROCEDURE PERFORMED?
The surgery will involve a general anesthetic so that you are asleep throughout the procedure. The surgeon will make a stab incision in the back. Small tubes called dilators, the size of a pen, are used to create a tunnel to the vertebra. An endoscope is then advanced to the site of the disc rupture which allows for superior visualization of the disc herniation and the neural elements. Given the small size of the endoscope often no or only a minimal amount of bone is removed to gain access to the herniated disc fragment. Specialized tools are brought in via the endoscope towards the disc herniation and disc material impinging the nerve root is removed. Once the surgery is complete, the anesthetic is reversed. The skin around the incision is injected with long-acting numbing medication and you are taken to the recovery room.
A healthy versus a herniated intervertebral disc
The endoscope is oriented in a way that safely avoids the spinal cord during the approach to the herniated disc.
WHY WOULD FULL ENDOSCOPIC DISCECTOMIES BE PREFERRED?
Three randomized controlled trials (the highest quality data in medicine) have shown that full-endoscopic provides similar or better functional results compared to minimally invasive technique while reducing the local and systemic tissue trauma, the length of hospital stay and the rate of complications {Ruetten, 2008 #63; Gibson, 2017 #64; Chen, 2018 #65}.
The transition from microsurgical to minimally invasive to full-endoscopic discectomy has dramatically decreased the invasiveness of procedures. Less invasiveness means fewer complications in spine surgery {Lee, 2012 #12}. We have shown that the rate of complications with full-endoscopic spine surgery is approximately 2.7% {Sen, 2018 #153}.
Additionally, modern endoscopes provide high-definition visualization of the neural elements and the disc herniation. This allows to carry out surgeries with an unprecedented precision.
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