Endoscopic Discectomy: Exploring Alternatives to Microdiscectomy
If you suffer from a herniated disc, you may have heard of microdiscectomy as a possible treatment option. Microdiscectomy is a minimally invasive surgery that involves removing a small portion of the disc that is pressing on a nerve root and causing pain, numbness, or weakness. Microdiscectomy can be effective for some patients, but it is not without risks and limitations. In this article you will learn about an alternative to microdiscectomy that may offer better outcomes and fewer complications: endoscopic discectomy.
What Is Endoscopic Discectomy?
Endoscopic discectomy is a type of spine surgery that uses a thin flexible tube called an endoscope to access the disc and remove the herniated material. The endoscope has a camera and a light at its tip, allowing the surgeon to see inside the spine and perform the procedure with precision and accuracy. The endoscope also has instruments attached to it that can cut, grab, or vaporize the disc tissue.
Unlike microdiscectomy, which requires a small incision in the back and muscle dissection, endoscopic discectomy can be done through a tiny puncture in the skin. This means less damage to the surrounding tissues, less blood loss, less pain, and faster recovery. Endoscopic discectomy can also preserve more of the disc than microdiscectomy, which may reduce the risk of recurrent herniation or disc degeneration.
What Are the Benefits of Endoscopic Discectomy?
Endoscopic discectomy has several advantages over microdiscectomy, such as:
- Shorter hospital stay – Most patients can go home the same day or the next day after endoscopic discectomy, while microdiscectomy may require a longer hospitalization.
- Faster return to normal activities – Patients can resume their daily activities within a few days after endoscopic discectomy, while microdiscectomy may take several weeks to recover from.
- Lower risk of infection – The small puncture wound of endoscopic discectomy heals faster and has less chance of getting infected than the larger incision of microdiscectomy.
- Lower risk of nerve damage – The endoscope allows the surgeon to see the nerve roots clearly and avoid injuring them during the procedure, while microdiscectomy may cause nerve damage due to poor visibility or accidental cutting.
- Lower risk of scar tissue formation – The minimal tissue disruption of endoscopic discectomy reduces the amount of scar tissue that can form around the nerve roots and cause chronic stiffness or pain, especially low back pain, while microdiscectomy may lead to more scar tissue formation and adhesions.
Who Is a Good Candidate for Endoscopic Discectomy?
Endoscopic discectomy is suitable for patients who have:
- A single-level or two-level herniated disc in the lumbar spine (lower back)
- Persistent symptoms of sciatica (leg pain, numbness, or weakness) that do not respond to conservative treatments such as medication, physical therapy, or injections
- No significant spinal instability, spondylolisthesis (slipped vertebra), or spinal stenosis (narrowing of the spinal canal)
Endoscopic discectomy may not be appropriate for patients who have:
- A large disc herniation that compresses multiple nerve roots or the spinal cord
- Severe spinal deformity or scoliosis
- Previous spine surgery in the same area
- Bleeding disorders or anticoagulant medication use
- Active infection or inflammation in the spine
How Can You Prepare for Endoscopic Discectomy?
If you are considering endoscopic discectomy, you should consult with a qualified spine surgeon who has experience and expertise in performing this procedure. The surgeon will evaluate your medical history, physical examination, and imaging tests (such as MRI or CT scan) to determine if you are a good candidate for endoscopic discectomy. The surgeon will also explain the risks and benefits of endoscopic discectomy and answer any questions you may have.
Before the surgery, you surgeon will recommend you:
- Stop smoking and drinking alcohol at least two weeks before the surgery, as they can impair healing and increase complications
- Stop taking any anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen) or blood thinners (such as warfarin or clopidogrel) at least one week before the surgery, as they can increase bleeding and bruising
You should also:
- Inform your surgeon of any allergies or medications you are taking, especially antibiotics, steroids, or diabetes drugs
- Arrange for someone to drive you home after the surgery and stay with you for the first night
- Follow your surgeon's instructions regarding fasting, bowel preparation, and hygiene
What Can You Expect During and After Endoscopic Discectomy?
Endoscopic discectomy is usually performed under local anesthesia with sedation, which means you will be awake but relaxed and comfortable during the procedure. You may also receive antibiotics and painkillers before the surgery. The surgery typically takes about an hour, depending on the complexity and number of levels involved.
During the surgery, you will lie on your stomach or side on a special table that allows the surgeon to adjust the position of your spine. The surgeon will make a small puncture in your skin over the affected disc and insert the endoscope through it. The surgeon will then use the endoscope to visualize the disc and nerve roots and remove the herniated material with the instruments attached to the endoscope. The surgeon will also flush the disc space with saline to wash out any debris or infection. The surgeon will then remove the endoscope and close the puncture wound with a bandage.
After the surgery, you will be transferred to a recovery room, where you will be monitored for any signs of complications. You may feel some soreness or numbness in your back or leg, which is normal and will subside in a few days. You may also receive some pain medication and anti-inflammatory drugs to ease your discomfort. You will be encouraged to walk around as soon as possible to prevent blood clots and stiffness. You will be discharged from the hospital once you are stable and comfortable, usually within 24 hours.
Make sure to follow your surgeon’s instructions regarding wound care, medication, activity, and follow-up visits. Avoid bending, twisting, lifting, or driving for at least two weeks after the surgery. You should also avoid sitting for prolonged periods or sleeping on your stomach. Gradually resume your normal activities as tolerated, but avoid any strenuous or high-impact activities for at least six weeks after the surgery. You should also participate in a physical therapy program to strengthen your core muscles and improve your posture and flexibility.
You should notice an improvement in your symptoms within a few days after the surgery, but it may take several weeks or months for the nerve root to heal completely. Report any signs of infection (such as fever, redness, swelling, or drainage), bleeding, worsening pain, or new neurological symptoms (such as weakness, numbness, or bladder or bowel problems) to your surgeon immediately.
If you are looking for an alternative to microdiscectomy that can improve your quality of life and restore your spinal health, endoscopic discectomy may be the right choice for you. Even though microdiscectomy surgery is a common and generally quite successful procedure, a hole is frequently left in the outer wall of the disc. In fact, patients with these large holes in their discs are more than twice as likely to reinjure themselves by having what is known as a reherniation. These reherniations often require additional surgery or even fusions. Fortunately, there is a new treatment specifically designed to close the large holes that are often left in spinal discs after discectomy surgery. Barricaid is a bone-anchored device proven to reduce reherniations, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital.
If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.
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