Disc herniation and lateral spinal stenosis are two conditions that can lead to severe back pain for many people. Sometimes the pain is temporary and is easily resolved with conservative treatments, such as rest, anti-inflammatory medications, steroidal injections, and rehabilitation. However, for others, the pain can be excruciating and long lasting, regardless of what is done to correct the problem. Advances in surgical techniques and medical instrument technology have brought on vast improvements in the treatment of these spinal conditions. This guide describes two new and exciting procedures available at the Bumrungrad Spine Institute. They are the least invasive spine surgeries to date to remove a portion of a herniated lumbar disc or decompress a constricted nerve root in lateral stenosis.
Endoscopic lumbar discectomy is done to remove the portion of a patient’s herniated disc in the lumbar region that is actually causing the patient discomfort while avoiding extensive tissue damage
-Very small incisions
-Reduced recovery and rehabilitation time
-Decreased risk of infection
-Minimal damage to surrounding, healthy tissues
This technique is usually performed under local anesthesia and neuroleptic analgesia. For the safety of the patient’s nerve elements, the physician is in constant communication with the patient and thus can avoid the risk of injury to a nerve. It is performed from the sides of the spine without injuring muscles, ligaments and bone structures. It is radiographed with a special portable x-ray machine located in the operating room (c-arm) so that the surgeon can at any time check the position of the micro-instruments in relation to the patient’s spine, thereby ensuring accuracy and safety. The endoscope transfers the image to a screen inside the operating room monitored by the surgeon. This image is enlarged, so the surgeon safely performs the surgery as the structures of the spine (nerves, intervertebral discs, ligaments, etc.) are clearly distinguished and the possibility of injury is minimized. Thus, the surgeon can remove an intervertebral disc, widen a spinal foramen, perform rhizotomy and generally all the endoscopic techniques depending on the patient’s condition, through a small incision with a diameter of 1 cm, that is, a regular surgery is performed with less risk, without destroying healthy structures. The special micro-tools that go through the endoscope are duplicates (miniatures) of all the tools used in the classic open spine surgeries except that they are thinner to go through the endoscope.
Before you have a minimally invasive spine surgery performed, you’re going to want to make sure that you have assistance in order to get home and to allow you to rest for a couple of days. A discectomy only takes about an hour and can be done under local anesthesia in our facility. However, depending on where your discectomy is and how you respond to local anesthetics, you may be numb so that you are unable to drive. If you have any allergies or are on medications that could increase the risk of bleeding, make sure your doctor is aware in order to avoid any complications. While the risks are small, there are still risks, and bleeding is one of them. Follow the doctor’s instructions for medications and food ingestion prior to your discectomy.
The patient can walk immediately after surgery. For people who do office work and other kinds of sedentary jobs, the time of recovery is usually one to two weeks. For more active people, like athletes and those who move around more often during their regular workday, the time of recovery may be four to six weeks. During the recovery period, you’ll need to participate actively in a physical therapy program. Physical therapy will help you recover and return to your regular activities faster. Some patients may also be required to take pain relievers during the recovery period.
A dural tear (cerebrospinal fluid leak)
- The leak does not change the results of surgery, but the patient may be asked to lie down for one to two days after surgery to allow the leak to seal.
Nerve root damage
Possible buildup of fluid in the lungs that may lead to pneumonia
Deep vein thrombosis, which occurs when blood clots form in the leg
Pain that persists after the surgery
Who is a suitable candidate for the procedure?
6 -12 weeks of conservative treatment have failed The patient exhibits profound leg weakness There is a loss of bowel and bladder control
How long do I need to remain in the clinic and when can I resume my activities?
The average surgical time required is 40 minutes. The patient’s stay in the hospital is about 3-5 hours in total. The patient walks immediately after being transferred to the ward, shortly after being transferred to bed. The patient can return to everyday activities on the same day or up to 3 weeks later and, depending on the type of work, the patient may return immediately for non-manual work or up to 3-6 weeks later (on average) for heavy manual work.
What are the success rates of this procedure?
The outcome of these surgeries is usually excellent with total pain relief immediately after surgery. The success rates are approximately 95%. Most patients report immediate improvement and return to their work and daily life without any problems.
What should I watch out for after the procedure?
Most patients can go home on the same day or early on the next day. Before leaving the hospital, a physiotherapist provides instructions on mobilization, that is, how to get out of bed and walk. It is also recommended to avoid weight lifting, as well as bending and rotational movements for 2-4 weeks to avoid recurrence of the hernia. Walking with gradually increased intensity is also beneficial, while seating for more than 45-60 minutes should be avoided.