Minimally invasive lumbar discectomy
Minimally invasive lumbar discectomy is the removal of the herniated portion of disc material to relieve compression on nerves in the lower back supplying the leg.
Discectomy can be performed in minimal invasive fashion with help of specialised tubular retractors or endoscope, minimising injury to muscle, ligaments and soft tissue. It can be performed in many ways:
1 ) Tubular lumbar discectomy
2 ) Interlaminar endoscopic lumbar discectomy
3 ) Transforaminal endoscopic lumbar discectomy
What is a disc prolapse?
Intervertebral disc is made up of an inner jelly-like material called nucleolus pulposus and a tough fibrous structure called annulus fibrosus. When there is tear in annulus due to ageing or degeneration of the spine, gel-like substance squeezes out through the tear and presses on the nerves leading to sciatica or leg pain. Disc herniation can occur anywhere in the spine, but most commonly in the lower back referred to as lumbar spine.
What are the symptoms?
Pain radiating from the lower back to one or both legs (sciatica )
An electric shock-like sensation in your legs
Numbness or tingling in the leg or foot
Weakness in legs or foot ( difficulty in gripping the footwear )
Bowel and bladder disturbance (urgency, loss of control, straining)
How is lumbar disc herniation diagnosed?
Patients presenting with these symptoms need thorough neurological examination and imaging (MRI – magnetic resonance imaging ). Interestingly not all disc prolapse causes symptoms and will require surgery, only a small percentage depending upon the symptom severity and nature disc prolapse on MRI.
What are the treatment options?
Conservative treatment – Self-care and restriction of activity, warm/cold compression therapy
Physiotherapy - Percutaneous electrical nerve stimulation (PENS) and Transcutaneous electrical nerve stimulation (TENS) reduce muscle spasm. Muscle-strengthening exercises help to strengthen your back and abdomen muscles, and posture training.
Pain medication – Analgesics, muscle relaxants
Spinal injections are referred to blocks, epidural steroid injection in the form of root or caudal block will be beneficial
Surgery is required in a small subset of patients who have recurrent episodes of pain not relieved with rest and pain medication, weakness of leg and loss of bowel or bladder control.
Surgery is performed in a minimally invasive fashion called keyhole surgery with the help of specialised tubular retractor or endoscope. It can be performed in many ways in a minimally invasive manner. The technique involves progressive dilation of muscle as opposed to traditional cutting through the muscle which is done open conventional surgery thereby minimising the damage to muscles, ligaments and soft tissue structures surrounding the spine. Avail advanced spine treatments from Best Spine Surgery Hospital in Bangalore.
1 ) Tubular lumbar discectomy – performed under general anaesthesia in the back with incision size less than 2 cms. With the help of tubular retractors, the muscles are kept out of the way and disc herniation is removed. The entire procedure is done with the help of a microscope.
2 ) Interlaminar endoscopic lumbar discectomy - Performed under general anaesthesia via small skin incision (less than 1 cms) from the back. An endoscope is inserted over the working cannula to access the interlaminar space to remove the herniated disc.
3 ) Transforaminal endoscopic lumbar discectomy - Small skin incision (less than 1 cm) is made on the flank (back). A needle is placed through the incision and disc is accessed through the intervertebral foramen. A guidewire is placed into the disc through the needle and needle is exchanged over the small tube. Surgery is guided by endoscope using fluoroscopy, usually done under general anaesthesia but can be performed in local anaesthesia also.
Can all disc prolapse treated in minimal invasive fashion - Yes