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Endoscopic Discectomy and Microdiscectomy

If you suffer from low back pain or sciatica that has failed to respond to conservative treatment, this revolutionary treatment may be an option for you.

What is a Discectomy?

A discectomy is a cutting-edge, minimally invasive procedure proven to reduce pain caused by disc herniations (sciatica) that are unresponsive to conservative, non-surgical therapy. Also called microlumbar discectomy (MLD), this is a truly advanced procedure whereby a physician can remove the herniated or protruding portion of an intervertebral disc that is compressing the spinal cord and affecting the nerve root – essentially shrinking an injured or bulging disc, taking pressure off of a painful nerve and reducing pain.

A discectomy is a safe and effective procedure that has been performed on over 100,000 patients around the world.  Compared to conventional spine surgery, there is less post-operative pain, faster recovery and a quicker return to the activities you love.

Indications

A discectomy is a minimally invasive procedure indicated for pain that has failed to respond to conservative treatments and therapy (i.e. medication, physical therapy, epidural injections, radiofrequency ablation, etc). Including:

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Herniated Disc New York NYC Treating herniated disc New York City NYC

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What Are The Benefits?

This revolutionary procedure has been proven to reduce pain and restore function in patients with low back pain and sciatica. Because this is a minimally invasive procedure there are a number of benefits:

Smaller incisions
Smaller, more cosmetically pleasing scars
Less pain
Decreased postoperative narcotics
Reduced operative time
Less soft tissue damage, due to reduced muscle retraction
Reduced blood loss
Less painful surgical incisions that heal faster
Faster recovery
Less postoperative pain
Many times can be performed as an outpatient
Quicker return to work and activities

More Details

Endoscopic Discectomy MicrodiscectomyTraditionally, the only way to reduce a herniated disc was through a large surgical incision and surgical exposure, i.e. “open” surgery. This typically entailed massive incisions averaging 5-6 inches long. The large wound created the possibility of damage to healthy and normal tissue:

  • Muscle damage in the process of the dissection and retraction needed to get down to the spine – this contributes to the formation of scar and fibrotic tissue around the spine and its nerves.
  • Blood vessel cauterization and bone removal.
  • Disrupting the natural anatomy of the spine.
  • Placement of screws and foreign devices.

While these aspects are necessary to facilitate decompression of pinched nerves and provide stability to the spine, they can also lead to:

  • Lengthy hospital stays (as many as 5 days or more)
  • Prolonged and even increased pain
  • Postoperative narcotic use
  • Longer recovery times
  • Blood loss from the surgery itself
  • Increased risk for infection

With the advent of minimally invasive surgery (MIS), physicians are now able perform a discectomy by approaching the disc with a small, minimally-invasive “keyhole” incision approximately one inch long to remove the disc herniation and allow for a more rapid recovery.

How Does It Work?

A discectomy is an outpatient procedure that is typically performed in one of three ways:

  • Percutaneous Discectomy – A small percutaneous (through the skin via a needle-puncture) probe is inserted into the disc and a small amount of the center of the disc is removed.
  • Microdiscectomy – A small incision is made in the skin and a special retractor is used to allow your physician to visualize the disc. Once the disc is visible, small instruments are used to shrink the disc under direct visualization.
  • Endoscopic Discectomy – A small incision in the skin is made (approximately 1 inch) and then a port is inserted and advanced down onto the disc. Then an endoscope (a thin telescope-like instrument with a lighted tube and camera attachment) is inserted through the port. This allows your physician to see the disc and surrounding tissue on a large monitor using the camera to transmit images of the disc. Then the procedure is performed by passing instruments through the endoscope to accomplish the same goal as a pair of hands. The light illuminates the area of the procedure and the camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine.

When Will I Feel Better?

Looking at xrayThe positive effects of the procedure varies from person to person.  Some patients report pain relief immediately.  As the procedure takes place in 2 parts (the removal of the excess disc material then the cauterization of the damaged disc lining) the healing/pain relief is felt in 2 phases.  

There will be some initial pain relief that will take place within the first week after the procedure as a result of the removal of excess disc material causing the disc to bulge or herniate. With the extra material is gone, the pressure on the spine will be relieved somewhat.

The second phase of relief is due to the cauterization of the disc lining – this can take up to 6 weeks to fully take effect.

Is a Discectomy Right for Me?

If traditional treatments and therapies have not provided you relief, a discectomy may be an option. It’s less aggressive and less expensive than major surgery. The procedure is minimally invasive by nature and the recovery time is drastically shorter.  Our doctor’s are proud to utilize the DiscFx Discectomy System from Elliquence for our patients.

Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate for this life altering procedure.

Procedure - Patient Details

Before the procedure starts, the staff will give you some antibiotics to minimize any risk of infection.  The procedure is performed under sedation – Monitored Anesthesia Control (MAC). Once you are comfortably asleep, your physician will sterilize your back then numb the skin with local anesthetic to make your recovery as painless as possible.  A thin needle is then inserted using fluoroscopy – a real time X-ray device that will allow your physician to visualize the needle the entire way and make sure it is properly placed inside the disc.  The tip of the needle is positioned just beyond the outer layer of the disc (annulus fibrosis) and placed into the center portion (the nucleus pulposis).

Once the needle’s correct position is verified a contrast solution is injected into the disc to allow your physician to visualize the inside. At this point, a series of dilator devices are inserted over the needle to allow a wider space to work and ultimately provide room for a thin port to be placed – giving access to the disc.

  • In the case of a percutaneous discectomy, a disposable probe will be inserted through the port and small amounts of the center of the disc are removed, thus making the whole disc smaller.
  • During a microdiscectomy, a special retractor is placed instead of a port. This will widen the area around the disc and your physician will then remove small portions of the disc to relief pressure on the injured nerves.
  • In the case of an endoscopic procedure, the endoscope is now inserted through the port and then smaller instruments are inserted through the endoscope. These instruments are used to shrink the disc using a small digital camera on the tip to visualize what is being done.

When performing a percutaneous procedure, the probe is removed and the procedure is now completed. In the case of the later two (microdiscectomy and the endoscopic discectomy) after enough disc material has been removed to take sufficient pressure off the spinal cord and/or the adjacent nerves, a small electro-cautery probe is inserted into the disc. This probe will cauterize the interior of the disc using a low electrical current. This will “seal” the interior of the disk, cause it to retract back into the spinal column, and, in the case of a painful annular tear – it will cause the tear to heal itself.

In some, the discs themselves can be painful (discogenic pain); this is determined using a test called a discogram. In the case of discogenic pain, this probe will cauterize any painful nerves within the disc, rendering the disc painless.

Your doctor may choose to place a few sutures to close the skin, but in many cases the wound is so small a simple bandage is all that is necessary.

Post-Operative Care and Recovery

Patients are generally not required to wear a back brace after surgery. However, patients may be issued a brace to provide additional lumbar support in the early postoperative period, as well to prevent particular motions and postures which may hinder the healing of the disc. Your doctor will typically provide you with pain medication to help control and post-operative discomfort. As this procedure is performed using the principles of MIS, your recovery time should be brief.

The wound area can be left open to air after a day or two. No bandages are required. Small surgical tapes affixing the suture should be left in place. The area should be kept clean and dry. Patients can shower immediately after surgery, but should cover the incision area with a small bandage and tape, and try to avoid water hitting directly over the surgical area. After the shower, patients should remove the bandage, and dry off the surgical area. Small surgical tapes affixing the suture should be left in place. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery.

Patients may begin driving when the pain has decreased to a mild level, usually 2-10 days after surgery. Patients should not drive while taking pain medicines (narcotics). When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. After patients feel comfortable with a short drive, they can begin driving longer distances alone.

Patients may return to light work duties as early as 1-2 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to heavy work and sports as early as 4-6 weeks after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy.

Patients will return for a follow-up visit in 1-2 weeks after the procedure and be given a prescription to begin physical therapy for back exercises 3-4 weeks after surgery.

Risk Factors

As with any medical or surgical procedure, there is always a risk of potential complication.  A discectomy is considered an appropriate non-surgical, minimally invasive procedure for patients suffering from back pain and sciatica.  Although there are potential risks, a discectomy is considered to be a safe and effective method for the treatment of painful disc herniations.

Many of the risks and complications are not related to the procedure itself, but the patient’s general health; severe complications are extremely rare.  Bleeding, infection, numbness, tingling, headache and paralysis may ensue due to a misplaced needle, retractor or port.  By using radiographic guidance, our doctors can ensure proper placement of all three and substantially reduce these associated risks.

To discuss the risks relating to your specific case, schedule and appointment to speak with one of our doctors in person.

Evidence of Performance

The discectomy is a truly remarkable procedure with many potential life-changing benefits. There is no shortage of evidence in peer-reviewed publications to support its use for treating refractory low back pain and sciatica. The safety and efficacy of this technology has been demonstrated with more than 100,000 interventions performed worldwide.[1-3]

Other technologies, like laser spine surgery, purport superiority to all other types of back surgery as well is claiming to be less invasive. Unfortunately, there is not a shred of evidence to support the use of laser spine surgery in any accepted neurosurgical or orthopedic journal. In fact, there is not a single peer-reviewed publication to speak of that supports its use as an effective treatment. It has never been supported through evidence-based medicine nor any of the available literature. Most importantly, the American Academy of Neurological Surgeons does not recognize laser spine surgery as an acceptable treatment,[4] nor is it part of the training or instruction at any academic institution. It is considered to be strictly a marketing ploy that preys upon the consumer’s fear of surgery.[5]

The discectomy, on the other hand, is considered an accepted and established treatment modality for disc herniations causing low back pain and sciatica. In 2009, a Hirsch et al published a Cochrane review of the available literature and established there was Level-II evidence to support the utilization of percutaneous lumbar discectomy to provide short- and long-term relief in patients with well-contained lumbar disc herniations.[6] In a study performed by Hellinger, patients were followed for up to 4 years after having received a discectomy for low back pain and sciatica. The patients in this study reported their low back pain and sciatica were reduced by 74% and 70%, respectively.[7]

The Ainsworth Institute is Here to Help

If you are suffering from chronic back pain or sciatica due to a disc herniation, contact the Ainsworth Institute of Pain Management today and schedule an appointment with one of our Board Certified Physicians to see if you are a candidate for one of these state of the art treatments.

References

[1] Andrews DW, Lavyne MH, Retrospective analysis of microsurgical and standard lumbar discectomy, Spine, 1990;15)4):329-35.

[2] Atlas SJ, Deyo RA, Keller RB, et al., The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica, Spine, 1996;21:1777-86.

[3] Barendse GA, van Den Berg SG, Kessels AH, et al., Randomized controlled trial of percutaneous intradiscal thermocoagulation for chronic discogenic pain. Lack of effect from a 90-second 70C lesion, Spine, 2001;26(3):287-92

[4] Perez-Cruet MJ. Is this the Future? Minimally Invasive Spine Surgery. Neurosurgeon. 2007;16(4):14-6.

[5] Ullrich Peter. “Laser Disc Decompression for Spinal Stenosis: Does it Work?” Spine-Health.com. p., 30 June 2007, Web 27 July 2014. http://www.spine-health.com/blog/laser-disc-decompression-spinal-stenosis-does-it-work

[6] Hirsch JA, Singh V, Falco FJ, et al., Automated percutaneous lumbar discectomy of the contained herniated lumbar disc: a systemic assessment of evidence, Pain Physician, 2009; 12(3):601-20.

[7] Hellinger S. Disc-Fx – A treatment for discal pain syndromes combining a manual and radiofrequency-assisted posterolateral microtubular decompressive nucleotomy. Euro Msk Review, 2009; 100-4.

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