Patients may be able to undergo a more modern procedure called an endoscopic discectomy if they require back surgery on only one level and they have no other complications. If a patient requires attention at several spinal levels and will likely need spinal fusion then an endoscopic discectomy may not be appropriate. In some cases a surgeon may commence a minimally invasive procedure only to discover that an open back surgery is necessary due to complications. Some patients with disc herniation at more than one level may be able to have minimal access surgery using a series of small incisions above each problematic disc.
An endoscopic discectomy involves a smaller incision being made above the herniated disc and a tubular retractor inserted to gradually nudge aside the muscles and nerves allowing access to the lamina. The surgeon will use a number of small, specialized instruments alongside an endoscope (a tube with a camera on the end) to perform the surgery. The endoscope’s camera will project a live image onto the monitors in the operating theater to allow the surgeon to visualize the field without having to open up the back in the same fashion as traditional back surgery. If several discs are being operated on then small sections of the lamina over each disc can be removed to provide access. By removing smaller portions of the lamina minimal access discectomy can allow the surgeon to forego the requirement of a spinal fusion procedure as necessary with most laminectomies. The intervertebral height may be maintained more successfully with the majority of the lamina left intact and problematic kyphosis (spinal curvature) can be avoided.
Benefits of an Endoscopic Discectomy
An endoscopic discectomy can minimize the trauma to the muscles and nerves and does not require the muscles to be dissected from the bone. Complications of muscle weakness in the back, and nerve damage, are therefore reduced with minimal access discectomy. The operation may be conducted under a local anaesthetic rather than general anaesthetic which allows for a quicker recovery and return to activity, reduces the risks of thrombophlebitis, and has less risk of respiratory or cardiac complication or allergic reaction to the anaesthetic. For some patients the open procedure is, however, necessary to increase the chances of a resolution of their symptoms and, although the faster recovery time from endoscopic surgery is attractive their surgeon may consider the minimal access procedure inappropriate.
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