A lumbar discectomy is a surgical procedure that is performed to remove herniated disc material from the lower back (lumbar), that is pressing on a nerve or the spinal cord. When this procedure is performed with the use of an endoscope, it is called a lumbar endoscopic discectomy. It is considered a minimally invasive procedure because only a small incision is necessary. In addition, the endoscope (a small metal tube with a camera and light on the end) provides direct visualization through magnified video images, as well as a passage way for the surgical tools, so the patient’s muscles do not have to be torn or cut. As a result of the minimal damage to bone and muscle tissue, most people who have a lumbar endoscopic discectomy experience less surgical trauma, and a quicker recovery period, than those who undergo more-invasive traditional back surgery.
The discs are cushions made of cartilage and other spongy tissue that run between the individual bones of the spine. Through aging, normal wear-and-tear or injury, discs within the lower back may bulge or herniate (rupture), and put pressure on adjacent nerves, resulting in pain, numbness or weakness in the lower back, legs or buttocks. When determining the exact cause of back or leg pain and developing a treatment plan, the physician performs a physical examination to check reflexes, muscle strength and movement. If nerve compression is suspected, additional diagnostic tests may include a CT scan, MRI scan, and a myelogram. An electromyogram and nerve conduction studies may also be performed to help pinpoint the location of the nerve damage.
Candidates for a Lumbar Endoscopic Discectomy
Candidates for lumbar endoscopic discectomy typically have herniated or bulging discs that produce pain, weakness or numbness that has not responded to conservative methods of treatment such as exercise, stretching, corticosteroids, pain medication or physical therapy. This procedure may also be an option to minimize pain and discomfort in those who have discs that are torn or chronic radiculitis (pain traveling down the leg). A lumbar endoscopic discectomy is often used to treat patients who have progressively worsening numbness or weakness in their legs and/or have serious mobility issues resulting from their condition.
Benefits of a Lumbar Endoscopic Discectomy
A lumbar endoscopic discectomy has many advantages over traditional back surgery. Benefits of this minimally invasive procedure include:
- Same-day surgery (outpatient procedure)
- Short recovery time
- Small incision and minimal scarring
- Minimal blood loss
- Retained spinal mobility
A lumbar endoscopic discectomy carries fewer risks than traditional spine surgery and as a result, patients recover more quickly and return more rapidly to day-to day activities.
The Lumbar Endoscopic Discectomy Procedure
Patients are sedated with general or local anesthesia prior to the procedure. A small incision is made on the side of the back, to allow the endoscope and other instruments to pass through into the disc space. A video monitor displays live, enlarged images transmitted from the camera on the endoscope. Once the instruments are in the disc space, the surgeon removes the damaged portion of the disc, as well as any disc material that is pressing against the nerves and causing symptoms. When this is completed, the endoscope is removed and the incision is sutured closed. A lumbar endoscopic discectomy takes about 1 hour to perform.
Risks of a Lumbar Endoscopic Discectomy
A lumbar endoscopic discectomy is considered a safe and minimally invasive procedure. As with any surgery, however, there are risks which include:
- Excessive bleeding
- Reaction to anesthesia
- Nerve damage
- Leakage of spinal fluid
After surgery, there is also a risk of disc herniation recurrence. If all of the disc tissue is not properly removed during the procedure, nerve pressure and symptoms may persist.
Recovery from a Lumbar Endoscopic Discectomy
Patients can generally return home the day of the procedure. Initial pain from the surgery may be treated with pain medication. Patients are advised to avoid bending, lifting or twisting for a few weeks after the procedure. Nerves may take some time to heal and patients may experience some temporary numbness and tingling in the legs. Most patients can return to work about 2 to 4 weeks after the procedure, however those with physically demanding jobs may have to wait longer to return to work. After the recovery phase, most patients experience a significant reduction in back and leg pain after undergoing a lumbar endoscopic discectomy.