Microdecompression Endoscopic
(Arthroscopic) Spinal Discectomy

with Laser Thermodiskoplasty
to Shrink and Tighten the
Bulging Disk

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Too many sufferers are not so fortunate. If one or more of their vertebral discs rupture and press on nerve roots, the pain that radiates from the back or neck and down the limbs can be incapacitating and severe.

 Until recently, often the only treatment was surgical removal of part of the ruptured disc; a major operation that required general anesthesia, the dissection of muscle, removal of bone, manipulation of nerve roots, and, at times, bone fusion. In an effort to overcome the disadvantages of traditional surgical techniques, the scientific medical community began exploring the use of endoscopy (arthroscopy). An endoscope (arthroscope) provides clear visualization and magnification of deep structures. This technology, first used in knee surgery, has been astonishingly successful in relieving pain. Now, because of advanced scientific technology and miniaturization, including fiber optics, video imaging technology, and experience gained through percutaneous spinal discectomy, there is a new and less traumatic discectomy procedure for some disc patients. It is Microdecompressive Endoscopic Spinal Discectomy, a form of Minimally Invasive Spinal Surgery.

Microdecompressive Endoscopic Spinal Discectomy is a new procedure for decompression of nerve roots damaged by spinal disc protrusions. Using the help of x-rays, fluoroscopy, and video for magnification and guidance, a small tube is inserted into the disc and a portion of the offending disc is removed.

Microdecompressive Endoscopic Spinal Discectomy is specifically designed for patients with uncomplicated herniated discs accompanied by the following:

1. Pain of the low back, neck or limbs.
2. Pain that has not responded to conventional treatments including physical therapy, chiropractic treatment, medication, exercise and rest for at least six weeks and pain management.
3. Positive corresponding neurological findings of reflex changes, muscular weakness, or decreased sensation
4. A positive CT scan, MRI scan, or myelogram for disc herniation.

This procedure is not designed for:

1. Patients with symptoms from advanced arthritis of the spinal joints, or large bone spurs that may cause a similar type of pain.
2. Evidence of neurological or vascular pathologies mimicking a herniated disc or of fractures, tumors, pregnancy or active infections.

It is performed only on patients with clinical symptoms confirmed by physical examination, x-ray, MRI, or CT scans.

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Depending on the type of surgery indicated, the procedure is done with the patient under either a local anesthesia (low back) or a brief general anesthesia (neck). Using high-tech x-rays, the endoscope and video image for guidance, a hollow tube for using a variety of surgical instruments inside, is inserted into the disc space. The instruments include mini micro forceps, curettes, trephines, rasps, burrs, cutters, and other types of probes. Lasers are also used to burn away portions of the disc, and to shrink and tighten the disc. The procedure takes about 40 minutes on the average. X-ray exposure is minimal. The discectome, a hollow probe, is used to suction and remove small pieces of disc material. Enough disc is removed for decompression of the nerve root. A laser is used to tighten the disc. The supporting structure of the disc is not affected. Upon completion a small band-aid is applied over the incision. This endoscopic procedure is used for bony decompression and soon will be attempted even for bone fusion and internal fixation/stabilization.

The patient may feel relief from pain immediately following this outpatient procedure. Some patients experience mild muscle spasms that can generally be relieved with muscle relaxants and analgesics. Pain at the site of the operation is usually minimal and requires no medication. Walking and exercising are usually encouraged on the day of discharge, and a daily exercise program is recommended. Re-evaluation is done several days later. Little, if any, postoperative medication is required for most patients and normal activities can usually be resumed at the doctor’s discretion within a few days to a few weeks.

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The primary advantage of this procedure is that there is no interference with the muscles, bones, joints, or manipulation of the nerves in the spinal area. Since it is an outpatient procedure there is no hospitalization required. It is less traumatic both physically and psychologically. It is done under local or brief general anesthesia which reduces risk. Because insertion of the tiny cannula through the muscle is the only wound, there is no scarring in or around the nerves postoperatively. The patient can begin an exercise program on the day of the procedure. The cost of surgery is approximately 40% less than conventional spinal surgery. The economic savings for the employee and employer are significant due to less time lost during recovery. At times, patients who have free fragments of disc in the spinal canal, as determined by x-ray, may also benefit from this arthroscopic procedure. It is essential to understand that not all patients are relieved of their pain by this procedure. Often more than 90 percent experience pain relief. There does not appear to be any detrimental effect from performing Microdecompressive Endoscopic Spinal Discectomy before the open microsurgical procedure to remove discs.

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Results with Microdecompressive Endoscopic Spinal Discectomy (a minimally invasive spine surgery) indicate hospitalization is not required. There is an earlier return to work and to previous daily activities. Some patients experience mild muscle spasms and transient pain. A small percentage of patients do not get relief of symptoms. Patients who initially have obtained good results appear to remain pain free.

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