Spinal Surgery for Lower Back Pain

Lumbar Discectomy

Introduction
Low back pain is the price human beings pay for walking upright. It is providing the United States with a massive economic headache.

Approximately 85% of inhabitants of the western world are afflicted with some degree of low back pain at some time in their lives. About 20% of our population has been incapacitated from 3 weeks to 6 months, and an estimated 6 to 8 million people have a permanent disability related to back pain.

In most cases, simple treatments like bed rest, exercise and pain medication bring relief. But many sufferers are not so fortunate. If one or more of their vertebral discs ruptures and presses on nerve roots, the pain that radiates from the back and down the legs can be incapacitating and severe.

For many the only treatment is surgical removal of part of the herniated disc. In the past, this condition has required a major operation called a laminectomy that is done under general anesthesia, consisting of dissection of muscle, removal of bone and manipulation of the nerve root.

Now there is a less traumatic procedure for some patients with disc problems called microdecompressive endoscopic lumbar discectomy with laser application, which is an outpatient procedure.

What is Microdecompressive Endoscopic Lumbar Discectomy with Laser Application?
Microdecompressive Lumbar Discectomy with Laser Application is a procedure to shrink and remove a portion of the herniated disc. Using local anesthesia and the help of x-rays for guidance, specially designed micro-instruments (the discectome and a laser probe) are inserted into the herniated disc space and a portion of the disc is removed by suction then the disc is shrunk by the laser in place of the open surgery.

Microdecompressive Lumbar Discectomy is different from standard lumbar disc surgery because the procedure involves no muscle dissection or bone removal. Only one tiny incision is made to accommodate the micro-instruments inserted into the herniated disc. Most complications that occur with open surgery are eliminated with microdecompressive lumbar discectomy.

The Procedure
The procedure is performed under local anesthesia with the patient awake and in a lateral position. A small needle is inserted into the disc space after local anesthesia has been administered.

Over this needle, a slightly larger probe is inserted to permit a 2mm incision to be made in the disc itself. Under fluoroscopic guidance, the micro-instruments (mini forceps, mini curettes, trephines, rasps, burrs, and mini cutters), the discectome and the laser probe are used in this surgery. Very small pieces of the disc material are removed and suctioned into the tip of the discectome and then cut by its knife. The laser is used for further removal of the herniated portion of the disc and shrinkage, for the purpose of disc decompression. The procedure takes about 30 minutes per disc, on average. X-ray exposures are minimal.

The supporting structure of the disc is not affected. Upon completion, the needle is removed and a small Band-Aid is applied to the needle incision.

Postoperative Course
The patient could feel relief from pain immediately following the procedure. Walking and light exercising is usually encouraged on the next day. Some patients experience lower back muscle spasms that generally can be relieved with relaxants and analgesics.

Pain in the area of the operation is usually minimal and requires no medication. From the day after discharge, a daily exercise program is recommended and there is a re-evaluation several days later. Little, if any, postoperative medication is required for most patients. Normal activities can usually be resumed at the doctor's discretion within a couple weeks.

Advantages
There are numerous advantages to microdecompressive endoscopic lumbar discectomy compared to open spinal surgery. Patients who have large free fragments of disc in the spinal canal, as determined by the x-ray, often can also benefit from this procedure. However, the laser can shrink the bulging disc further for disc decompression. Some advantages are:

One of the advantages of the percutaneous endoscopic (arthroscopic) lumbar discectomy approach is that it is performed with much less tissue trauma when compared to an open surgical procedure.
Hospitalization is not required since it is an outpatient procedure.
Faster recovery since it is an outpatient procedure.
Minimal to no scarring in and around the nerves post operatively.
Earlier return to work and to daily activities.
Patients can begin an exercise program the day after surgery.
We estimate the cost of endoscopic surgery is 40% less than conventional spine surgery.

Not all patients are relieved of their pain with this procedure. Approximately 90 percent of patients have experienced pain relief. Patients who do not obtain relief within three to six weeks may be considered for micro-surgical disc removal, depending on the circumstances. If the endoscopic procedure is not effective a patient could still be a candidate for future open micro surgical procedures. This procedure does not prevent or preclude any future spine surgery including fusion, if necessary.

Who Should Consider This Procedure?
This procedure is specifically designed for patients with uncomplicated, herniated discs accompanied by the following:

Low back and leg pain
Pain that has not responded to conventional treatments, rest, physical therapy, chiropractic treatment, and medications
A positive CT or MRI scan for disc herniation
Often extruded discs can be helped
A positive provocative discogram

The procedure is not designed for:

Patients with symptoms from arthritis of the spinal joints.
Evidence of advanced spondylosis (significant bony spurs) with disc space narrowing, diffuse annular bulging and other spine irregularities
Existence of other pathologies or conditions such as fractures, tumors, or active infections
Neurological or vascular pathologies mimicking a herniated disc

Other surgical procedures, including micro-surgery, can be used for those patients who cannot have this procedure. Only patients with clinical abnormalities confirmed by physical examination, x-rays and tests are considered for the procedure.

Summary
The Microdecompressive Lumbar Discectomy with Laser Application requires no hospitalization, allows for earlier return to work and earlier return to previous daily activities compared to open spine surgery. Rare patient complications include muscle spasms of the lower back. A small percentage of patients do not get relief of symptoms. Patients who initially have obtained good results often remain pain free.

If you have any questions, please feel free to further discuss the Microdecompressive Lumbar Discectomy procedure with us.