Lumbar Endoscopic Discectomy is a minimally invasive alternative to the open surgical approach for lumbar discectomy. It is indicated in patient with herniated disc, experiencing lower back and leg pain. However, the choice between a lumbar endoscopic discectomy and an open procedure depends on the preference of the surgeon and the condition of the patient.

The complete surgery is performed through a small tube or trocar, inserted through the skin, down to the disc. The goal of surgery is to remove the herniated disc which is exerting excessive pressure on the spinal nerves to relieve the patient’s lower back and leg pain. Throughout the procedure, the surgeon is able to visualize a magnified image of the entire working area on a monitor with the help of an endoscope inserted through the trocar. The endoscope has a camera and a light source at its end which allows a better visualization of the work area and aids in precise removal of the damaged tissue. Moreover the whole procedure is performed under fluoroscopic guidance which further aids in the location and visualization of the herniated disc during the surgery, and results in better outcome. This procedure has a shorter recovery time as the muscles are retracted and not cut, as opposed to the open approach.

Procedure

The patient lies face down on the operating table. The patient is then administered a mild sedative to keep them relaxed throughout the procedure. A small incision is made on the skin over the back of the patient, just above the disc space. A thin wire is inserted through the incision till it touches the damaged area of the spine under fluoroscopic guidance. A tube is then inserted through the same incision, over the guide wire. The endoscope and other special micro-surgical instruments are introduced through this tube and the segment of the herniated disc compressing the nerves is removed. The endoscope and intra-operative fluoroscopy guide the surgeon throughout the procedure. The tube and the endoscope are then withdrawn and the incision is closed.

Post–operative care

The patient is usually discharged home on the same day of the surgery. Most patients experience a significant reduction in their back and leg pain after the procedure. The numbness and tingling sensations may take some time to resolve. The patients are advised to avoid bending, lifting or twisting for a few weeks after the procedure. There are chances of recurrence of a herniation at the same level, which can cause the back and leg pain to reappear.

Risk and Complications

Lumbar Endoscopic Discectomy is a relatively safe procedure. However, some of the risks associated with this surgery may include infection, bleeding, nerve damage and leakage of spinal fluid.