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Endoscopic Spinal Techniques

Endoscopic Spine Surgery

Endoscopic spine surgery is a minimally invasive spine surgery that uses specialized video cameras and instruments to remove the herniated disc through very small incisions. The approach is made through the back, chest or abdomen, to gain access to the spine to perform the surgery.

Endoscopic spine procedures are performed using a tool called an endoscope, a thin tube with a tiny video camera on the end of it. The camera displays the images of the inside of the body onto the television screens, helping the doctor see what is going on. During your procedure fluoroscopes (x-ray machines) are used to provide the best views of your spine. The endoscope is inserted through a small cut and guides it to the affected area. Your doctor uses x-ray and the camera to find the fragment and special instruments to remove the fragment. The incisions are closed with sutures and covered with surgical tape.

Preprocedure

Before the procedure, your surgeon may advise you to stop smoking and to exercise regularly to improve your recovery rate. Any nonessential medications or herbal medications that increase surgical risk should be discontinued before surgery. Before your surgery you can ask your surgeon any questions you may have.

Post Procedure protocol

With endoscopic spine surgery most patients usually return home within two days after surgery. Physiotherapy and occupational therapy is given to mobilize the spine and loosen the muscles. To avoid strain injury you may be instructed to avoid bending, lifting, and twisting for the first 2 to 4 weeks.

Endoscopic spine surgery is considered as a last resort for treating spinal conditions in the neck and back when conservative treatments have failed to improve your symptoms.

Endoscopic spine surgery is used to treat a variety of spinal disorders and conditions, including

  • Degenerative disc disease
  • Herniated discs
  • Sciatica
  • Scoliosis or other spinal deformities
  • Spinal fractures
  • Spinal infections
  • Spinal tumors

Benefits

Traditional open surgery typically requires a larger incision, muscle stripping, longer hospitalization and increased recovery time. The advantages of endoscopic procedures when compared to the traditional procedures include the following:

  • Small incision and minimal scar tissue formation
  • Less blood loss
  • Less damage to the surrounding tissues
  • Faster recovery
  • Quick return to normal activities
  • Decreased hospital stay
  • Less postoperative pain
  • Reduce the risk of infection
  • Improved function

Risks/Side effects

Like any type of surgery, there are certain risks associated with endoscopic spine surgery, such as:

  • Reaction to anesthesia
  • Blood clots
  • Blood loss
  • Infections
  • Nerve injury
  • Need for additional surgeries
  • Pain
  • Instruments can break, dislodge or irritate the soft tissues

Lumbar Endoscopic Discectomy

Lumbar endoscopic discectomy (LED) is a minimal invasive surgical procedure employed for the removal of the damaged portion of the intervertebral disc responsible for lower back pain. LED is an advanced surgical technique that employs X-ray imaging and video guidance to navigate the endoscopic probe to the herniated disc space.

The benefits of lumbar endoscopic discectomy over the traditional open surgery include:

  • Minimally invasive
  • Less blood loss
  • Operated under local anesthesia
  • More precise with a high success rate
  • Small incision and rapid recovery
  • Discharged on the same day
  • Does not affect the spinal mobility

Lumbar endoscopic discectomy is employed in the management of various spinal conditions such as herniated disc, disc tear, radiculitis and radiculopathy affecting the lumbar region of the spine. LED is recommended for lower back or buttock pain persisting beyond 10-12 weeks, or similar pain not responding to conservative treatments such as physical therapy, chiropractic care, acupuncture, medications and spinal injections. LED is also recommended in the patient with nerve root compression or irritation.

Procedure

Lumbar endoscopic discectomy surgery involves the following steps:

  • Patient is placed on the operation table and a local anesthesia is administered at the lumbar region
  • A small metal tube (portal) is then inserted in the affected lumbar region, under fluoroscopic guidance. This tube serves as a transit for the surgical tools, which avoids the need to cut muscles as in open discectomy.
  • A tiny camera or endoscope is also inserted through the portal which helps to visualize and evaluate the condition of the damaged spine.
  • With the help of X-ray fluoroscopy and enlarged video images, pieces of the herniated disc are precisely removed with a grasper.
  • Conditions such as disc bulge and annular tears are treated with a laser.
  • The laser vaporizes the disc material as well as consolidates the disc, preventing any further leak of the disc material to the surrounding nerves.
  • Finally, after the procedure, the tube is removed and the incision is sutured.

Post-operative care

The majority of patients experience immediate pain relief, after the surgery. The patient is discharged home the same day of the surgery. Some patients may experience post-operative pain, due to muscle spasms, which may persist for a few days. Your doctor may prescribe medications such as muscles relaxant and pain killers or advise heat application for the management of this pain.

Risks

Risks and complications associated with LED surgery are comparatively low. Some of the potential risks include bleeding, infection, and leakage of the spinal fluid, nerve injury and recurrence of disc herniation involving some other disc.

News & Events

Dr. Josue P. Gabriel frequently gives lectures for the benefit of furthering scientific research and medical education.