The original procedure used for lumbar herniated disc was the procedure called Discectomy which is somewhat different than the Micro-Discectomy procedure. This procedure is used for patients with the diagnosis of Lumbar Disc Herniated . Discectomy was performed by placing a relatively large incision over the affected area. Retractors are placed and the bony elements of the spine are approached. Bony elements are removed and the spinal nerves are retracted to expose the herniated disc. Once it is removed, routine surgical closure is performed.
In recent years with the enhancement of the operative microscope smaller incisions were utilized to reach the operative goals of discectomy. The microscope allowed improved visualization with magnification and illumination in a smaller incision. The operative microscope allowed simultaneous visualization in the wound to the assistant as well. This procedure is the simplest one and uses traditional surgical techniques. A small incision is made and small retractors are placed within the wound which allow the visualization of the spine. Once the bone is visualized, magnification apparatus like a microscope (as shown to the right) is used to perform the operation. This procedure is safe since it allows magnified visualization and the problems within the canal can easily visualized and corrected. However, this procedure requires the greatest amount of dissection of soft tissue which may require a hospital stay after the surgery. Usually, patients are kept in the hospital for one or two days after the operations to ensure good pain control and ability to walk Some surgeons point to the fact that risk of infection is also higher with larger incision and more operative dissection which is utilized with this operation as compared with other options. One must remember that this procedure is a time honored technique which has been proven to be very effective.
Recently, endoscopic technology been developed to reduce incision size, with decreased need for dissection with improved visualization. This allows the achievement of the operative goal in the same manner with faster recovery and decreased post-operative pain. Some patients may be a candidate for the Micro-Endoscopic Discectomy rather than Micro-Discectomy. These patients may benefit from faster recovery with same day surgery and can be discharged the same day home. Patients with very large herniation or specific types of herniation may not be a candidate for endoscopic procedure. Your spine surgeon is best able to identify these specific situations and advise you of the best decision making plan.
