Endoscopic Discectomy |
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Cervical Disc Replacement |
Endoscopic
Discectomy DEFINITION: Lumbar discectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. Before the disc material is removed, some of the bone from the affected vertebra may be removed using a laminotomy or laminectomy to allow the surgeon to better see the area. Microdiscectomy has become the "gold-standard" technique for unilateral disc resection. The surgeon usually performs the operation with a surgical microscope and only needs to make a very small incision in the low back; it is often categorized as minimally invasive surgery. Recent advances in surgical instrumentation have allowed surgeons who are adequately trained to perform the same procedure through an Endoscopic approach. This involves performing the surgery through a small incision using a small camera inserted into the wound. The advantage of this approach over conventional microdiscectomy is that there is very little need to retract muscles and therefore there is far less pain and a lower risk of wound complications postoperatively. In some cases, the prolasped disc is larger than expected and the endoscope is used to only assist the microdiscectomy procedure to minimise soft tissue retraction. Lumbar discectomy can alleviate symptoms from a herniated disc in the low back. The main goal of discectomy surgery is to remove the part of the disc that is putting pressure on a spinal nerve root. Taking out the injured portion of the disc also reduces chances that the disc will herniate again.
Lumbar disc protrusions are not usually operated upon early, but there are some clear situations when we may recommend early surgery: - -If there is evidence of severe weakness, early surgery may be offered. -If the pain in the leg is so severe that narcotic analgesia is not controlling the pain, early surgery may again be an option. -Finally, if there is a suggestion of problems with the nerves that supply the bladder or bowel, early surgery is advocated. In this latter situation, an inability to pass urine may be evident, or there may be numbness in the crotch area, buttocks or when passing urine. This situation usually necessitates emergent or early surgery. The procedure can be performed as a day stay surgery, but most patients stay in hospital for 1-2 nights. General anaesthesia is utilized and the surgery is performed through a small incision. Discectomy surgery is usually done with the patient kneeling face down in a special frame. In the majority of cases a small incision and endoscopic surgery is is performed, but sometimes the surgery cannot be performed through this approach ie obesity, difficulties during surgery etc, and therefore a more standard approach is used. Usually a small window is made on one side of a spinous process through the removal of some bone and ligament to allow visualization of the disc bulge and involved root. Through gentle dissection under illumination and magnification, the interface between the root and disc bulge is identified and the offending fragment is removed. Only a small portion of disc is removed. The whole disc is not removed, although any loose fragments felt through the hole in the annulus are removed. The tear in the annulus is not repaired. After the nerve is freed completely the operation is completed. Typically this takes 1-2 hours to perform. PROBLEMS:Infection is an important risk and most be considered in all operations. The infection rate in most centres is usually below 2% and patients are usually given prophylactic antibiotics. Problems with anaesthesia include drug reaction and respiratory problems. The chance of a serious or permanent complication is less than one in a thousand. These issues are usually short term and can be discussed with the anaesthetist. Thrombophlebitis (Blood Clots) can precipitate as clot in the veins of the thigh called DVT (deep venous thrombosis), clot in the lungs PE (pulmonary embolism. Usually pressure stockings to keep the blood in the legs moving are used post operatively and medications that thin the blood and prevent blood clots from forming are administered if this condition is suspected. Active movement is advised as soon as possible. Nerve damage- cutting the nerve tissue with a surgical instrument, swelling around the nerve, or the formation of scar tissue can cause muscle weakness and a loss of sensation to the areas supplied by the nerve Painkillers can reduce ongoing pain. POST PROCEDURE:Usually able to get out of bed within a few hours after surgery. The drain tube is normally taken out the day after surgery Most patients leave the hospital the day after surgery. In most cases you would be able to get back to light work in two to four weeks and can do heavier work and sports within two to three months. Many surgeons prescribe outpatient physical therapy within three weeks after surgery. Physical therapy after lumbar discectomy is generally only needed for six to eight weeks. You should expect full recovery to take up to four months As your condition improves, your therapist tailors your program to help prepare you to go back to work
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