For many years the standard of care for patients undergoing removal of a herniated disc was the procedure referred to as Micro-Discectomy. Even today, most spine surgeons continue to perform this procedure to remove a herniated disc for patient suffering of this illness. The endoscopic procedure uses the same operative principles and tactics to achieve the same end result, namely, removal of the herniated disc fragment, decompression of the affected nerve with the least dissection and disruption of normal tissue.
In order to appreciate the advantages of the endoscopic procedure (MED) one must first understand the basics of the traditional and routinely performed Micro-Discectomy procedure. In order to remove the herniated disc fragment, the patient is anesthetized and is positioned on the operative table facing the floor. The back is exposed, and an incision is made which is approximately 3 inches in length. The underlying muscles are exposed and are pushed aside to expose the bony elements of the spine. Generally, it is the muscular dissection that leads to postoperative pain and spasm. At that time a small amount of bone is removed to expose the affected nerve and herniated disc. An operative microscope is used to better visualize the spine. The nerve is carefully retracted while being visualized under the microscope, and the disc fragment that is herniated is removed, freeing the nerve. Patients usually remain in the hospital for one day for pain control prior to discharge. Excellent results have been obtained for many years with this procedure. The downfall of this procedure is the relatively longer recovery time since there is more muscular dissection to reach the operative goals.
The Micro-Endoscopic Discectomy procedure (MED) takes advantage of technologically superior instruments to achieve the same operative goals with smaller incision, decreased dissection, and decreased disruption of normal tissue. Over the past decade endoscopic procedures have been gaining popularity since these procedures lead to faster recovery with great success. In some cases, these procedures have become the standard of care. For example, removal of gall bladder by general surgeons is now routinely performed by Endoscopy/Laparoscopy. Most surgeons now agree that it is the procedure of choice. Endoscopic / minimally invasive technology allows improved visualization, magnification, while reducing complications using state of the art technology and instruments. Theoretically, the risk of infection is decreased since the wound is smaller. This by itself is a major advantage since it is a dreaded complication for any patient and surgeon.
As with the Micro-Discectomy procedure, patients are positioned in a similar manner on the operative table. An incision in the size of a dime is made in the specific area of interest. Since the incision is very small, there is negligible amount of muscular dissection performed. Specialized retractors are placed in the incision site until the bony elements of the spine are reached. An endoscope is a very small camera which is used in this procedure. This Endoscope is then placed within the retractors into the wound. We obtain superior, magnified visualization using the camera which allows precise movements about the spine. At that time, the procedure continues in a very similar manner to the traditional Micro-Discectomy procedure as described above. Small amount of bone is removed to expose the affected nerve and herniated disc. At that time a microscope can also be used to visualize the spine as well. The nerve is visualized, retracted to the side, and the herniated disc is removed. After achieving the operative goal, the retractors are removed, and the incision is closed. Since the incision is so small, some surgeons choose to place a band aid over the wound. As healing progresses over several days, the body will produce scar tissue under the skin which contracts the wound achieving even smaller scar in the area. Usually the scar is not noticeable after healing has completed.
Since very little dissection is performed, post-operative pain is substantially less than the traditional Micro-Endoscopic procedure. This advantage allows patients to go home the same day of surgery. Pain control is achieved using oral pain medications and occasionally muscle relaxants. No brace is necessary and patients are allowed to perform routine daily activities. Depending on the type of occupation, patients are allowed expedited return to work within one or two weeks.
