SPINE PROCEDURES

Posterolateral Endoscopic Discectomy
Minimally invasive procedure to treat herniated disc now being performed by Long Island Spine Specialists

Back and leg pain often result from something called a lumbar herniated disc, which is caused by nerves being compressed by surrounding tissues.

Disc herniations can be treated in a variety of methods, though in some instances a surgical intervention is required. Open decompression procedures such as microdiscectomy and laminectomy have traditionally required an incision ranging from one to four inches. These approaches necessitate trauma to muscle tissues and requires removal of vertebral bone.

A new minimally invasive, outpatient procedure known as posterolateral endoscopic discectomy is now being performed. This procedure has been performed for several years now and is increasing in popularity. Posterolateral endoscopic discectomy is a viable alternative for radiculopathy, especially for certain types of lumbar disc herniations. It offers several significant advantages over the open decompression procedures:

• Light sedation, not general anesthesia, is used
• Incision size is generally under 8 mm
• Earlier functional recovery and less postoperative pain.

The Procedure
These procedures are performed either at a same-day surgery center or at a hospital as an outpatient.

This surgical procedure involves the surgeon accessing the lumbar disc via a tubular portal, through which specially designed tools, including an endoscope and various probes and forceps, can be passed. The surgeon will approach the lumbar disc herniation from a direction which is posterior (from the back) and lateral (from the side).

The first step of the procedure involves xray tracking of the steps in order to gain access to the disc. The surgeon begins by placing a needle through the layers of tissue towards the problematic disc. A local anesthetic is used to reduce any pain caused by this step. A guidewire is then inserted through the needle, and a dilator is then passed over the guidewire. The guidewire is removed, and a seven millimeter diameter tube is placed over the dilator, and inserted into the annulus, the outermost portion of the disc.

Through this small tube, the endoscope and other tools are passed. The surgeon actually can directly visualize the inner portion of the disc (the nucleus pulposus) and can remove parts of the herniated disc, decompressing the nerve root.

The surgeon will continue to remove portions of disc which are interfering with the nerve roots, until the pain has subsided. After the procedure has been completed, a small adhesive strip will be used to close the small incision. Recovery from the light sedation is very fast, and often patients can leave the hospital soon after.

Prior to Surgery
You should stop taking all aspirin, non-steroidal anti-inflammatory medications (NSAID’s), and alcohol fourteen to sixteen days before your procedure or as directed by your doctor. If you take aspirin for a heart or vascular condition, please consult your doctor.

You should not eat or drink anything after 10 p.m. the evening before your procedure, including water, juice, or coffee.

After Surgery
Often, you may be discharged as soon as one hour after your procedure. However, you must remain in the recovery room until your doctor has checked your alertness. You should plan to have a friend or family member to drive you home.

It is possible that you may be advised to stay overnight in the hospital, but this is quite rare. However, you should rest comfortably at home, ensuring that you do not overexert yourself. If you are from out of town, it is usually safe to travel within 48 hours of your procedure.

There may be discomfort in the surgical area. You may take aspirin, NSAID’s, or muscle relaxants as indicated by your doctor.

The local anesthesia used in the procedure may leave you with some numbness or weakness in your leg, but this will generally begin to subside within a day of your surgery.

You should plan to see your doctor for post operative follow-up in the office about a week or two after surgery. Depending on the type of work that you perform, you may be able to return to work in between one and four weeks.

Known complications of the endoscopic discectomy include infection, dural tears, dysesthesia (post operative burning pain which emanates into the lower extremities), and nerve injury, These complications may require additional surgery to resolve.

If you have questions or concerns, please do not hesitate to ask your doctor.

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