Tuesday, May 26, 2015

ENDOSCOPIC DISCECTOMY: Minimum surgery, Maximum relief…

The SPINE lends structural stability and balance to our body helping us stand upright, while allowing flexibility in various movements. Moreover, it forms a protective canal in which the SPINAL CORD, the most important part of the neural network, flows down from the brain to the rest of our body. The spinal column is an interconnected structure of bony (vertebrae) and cartilage tissues (intervertebral discs) and it is prone to age related wear and tear. Read through to learn more about a HERNIATED DISC, its manifestations and treatment options, with special reference to a minimally invasive surgical technique called Endoscopic discectomy.
What is a herniated disc?
First, let’s understand an intervertebral disc. It is essentially a disc shaped, rubber like tough and flexible structure made of outer layers of fibrous cartilage with a softer gel like tissue in the center. A disc lies between two adjoining vertebral bones of the spine and acts as a shock absorber. This disc undergoes wear and tear changes (degeneration) after a certain age. When the degenerated disc is subjected to any external strain or injury, the substance from the central part of the disc comes out through the tears in the outer fibrous layers. This condition is called a herniated disc. It is also referred to as prolapsed or slipped disc. A disc prolapse can occur in any part of the vertebral column; but, mostly observed in the lumbar (lower back) or in cervical (neck) region.
What happens when an intervertebral disc herniates ?

When the inner disc material protrudes through the disc surface, it may pinch or irritate the nerve roots it comes in contact with. It also elicits a severe inflammatory chemical response in that area. If this happens in the lumbar spine, it induces symptoms such as:

  1. Pain in the back,
  2. Pain running down the leg,
  3. Weakness of the muscles in the leg supplied by the affected nerve root,
  4. Numbness or tingling sensation in the respective part of the leg.
  5. Loss of bladder and bowel control if a large disc prolapse compresses multiple nerve roots.

If you feel recurring radiating pain in any of the body parts, it would be a good call to see a Spine specialist. 

What causes disc herniation?
Disc herniation happens as a result of degeneration that is mostly related to the genetic composition of the person. Smoking is another well established factor that causes disc degeneration. Other factors also play a role in the process of wear and tear of the discs. Though the exact reason is hard to pick, disc herniation may be precipitated by strain on the spine during physical work, certain kind of frequent body movements or spinal injury due to any accident. Sometimes adopting improper body posture for physically demanding jobs of time may result in this condition.

What are the treatment options for herniated disc condition?
Most cases of disc herniation can be treated medically with rest, pain relievers, anti-inflammatory medication and physiotherapy. But, if the symptoms persist or the pain is severe or if it is affecting the nerve function causing numbness and weakness, it needs surgical intervention. 

Minimally Invasive (Endoscopic) Spine Surgery
Spine surgery is generally adopted as the last resort to treat painful disc prolapse that do not respond to medication for a longer period (usually 3 months). Rarely, a severe nerve compression causing weakness of muscles or severe sciatica may need surgical treatment straight away. Conventional open surgery involves cutting the muscles and removing some portion of bone in the spine, which has its own complications and disadvantages. But, the advent of high definition image guided systems and surgical tools, now-a-days spine surgery for herniated discs can be done with minimal invasion. 
Endoscopic Discectomy for herniated disc is a minimally invasive spine surgery carried out through a one centimeter incision on the back. It involves removal of herniated disc material that protrudes and compresses the adjacent nerve roots, through specially designed spine endoscopes that help in clear visualization of the structures. Instead of cutting the muscles in an open surgery, endoscopic surgery involves dilation of the muscles causing much less damage and procedure related pain. It can also be performed under local anesthesia as a day care procedure in suitable patients. 
It is a complicated procedure requiring high degree of expertise and long years of practice. Though endoscopic spine surgeries like TED have become common place in western countries, in India it is still in a nascent stage. 

The procedure of Endoscopic Spine Surgery are:

  • The patient is positioned lying face down.
  • On table x rays are taken to locate the entry point for the affected disc
  • A small injection is given to anesthetize the skin at the entry point
  • The track to the disc is found with a needle and the track is dilated without cutting muscles
  • Endoscope inserted into the disc and structures visualized
  • Prolapsed disc fragments removed under direct clear vision.
 The advantages of Endoscopic Spine Surgery are:
  • A small incision of less than one centimeter is made on the back
  • Minimal muscle or bone damage
  • Minimal  blood loss
  • Can be done as a day care procedure.
  • Minimal risk of infection
  • Less painful then open surgery
  • Cost of treatment and recovery comparatively low.

Though it is fast emerging as a procedure of choice for herniated disc conditions, Endoscopic Discectomy may not be suitable for everyone. The patient selection for suitability of the procedure is very crucial and the decision is best made by an experienced spine surgeon who understands the pros and cons of the procedure.

Dr. Phani Kiran S
Consultant Spine Surgeon
Global Health City, Chennai


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