Spinal Surgery For Ruptured Disc, Herniated Disc & Other Spinal Disc Problems

Introduction

Back and neck pain is the price human beings pay for poor posture, prolonged sitting, lifting, repeated bending, obesity, and injury from accidents. 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 back or neck pain at some point in their lives. About 25% of our population has been incapacitated for two weeks or more and possibly 8 to 10 million people have a permanent disability from it.

In most cases, simple treatments such as bed rest, exercise, physiotherapy, and pain medication bring relief. 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 or neck and down the limbs can be incapacitating and severe.

Until recently, 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 minimally invasive spinal surgery, there is a less traumatic discectomy procedure for some patients with disc problems. It is Microdecompressive Spinal Discectomy, a form of minimally invasive spinal surgery.

What is Microdecompressive Endoscopic Spinal Discectomy?
Microdecompressive Spinal Discectomy is a procedure for decompressing nerve roots damaged by spinal disc protrusions. Using the help of x-rays, fluoroscopy, endoscopy, and video for magnification and guidance, a small tube is inserted into the disc and a portion of the offending disc is removed. The procedure is also sometimes used for the removal of small bony spurs (osteophytes). This procedure is different from standard disc surgery because it is performed with much less tissue trauma when compared to an open procedure (no muscle dissection, bone removal, or bone fusion). The incision is tiny enough to close with a small Band-aid. Therefore, most complications that occur with conventional surgery are eliminated with this procedure.

Who Should Consider This Operation?
Microdecompressive 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 rest, physical therapy, chiropractic treatment, medication, exercise, 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
5. Positive provocative discogram

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
3. Fractures, tumors, or active infections.

Microdecompressive Spinal Discectomy is performed only on patients with clinical symptoms confirmed by physical examination, X-ray, MRI, or CT scans.

The Procedure
Depending on the type of surgery indicated the procedure is done with the patient under either a local anesthesia or in some situations, a brief general anesthesia (some times for cervical procedures).

Using fluoroscopic x-rays, the endoscope and video image for guidance, a hollow tube is inserted into the disc space. A variety of surgical instruments could be used through the hollow tube, including mini-forceps, curettes, trephines, rasps, burrs, cutters, and other types of probes. A 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 shrink and tighten the disc and remove portions of the disc. The supporting structure of the disc is not affected. Upon completion a small Band-aid is applied to the incision. The procedure takes about 30 minutes per disc, on the average. X-ray exposure is minimal.

This endoscopic procedure is used for bony decompression and soon could be attempted even for bone fusion and internal fixation/stabilization.

Postoperative Course
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 light exercising are usually encouraged on the day after discharge, and a daily exercise program is also 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 couple weeks.

Advantages
There are numerous advantages to microdecompressive endoscopic cervical discectomy compared to open spinal surgery. Patients who have large free fragments of disc in the spinal canal, as determined by the x-ray, cannot benefit from this procedure. However, the laser can shrink the bulging disc further for disc decompression. Some advantages are:

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

At times, patients who have free fragments of disc in the spinal canal, as determined by x-ray, might also benefit from this arthroscopic procedure.

Not all patients are relieved of their pain by this procedure. Often more than 90 percent experience pain relief. If the endoscopic procedure is not effective, a patient could still be a candidate for open microsurgical procedure to remove discs. This procedure does not prevent or preclude any future spine surgery including fusion, if necessary.

Summary
Microdecompressive spinal discectomy requires no hospitalization, allows for earlier return to work and return to daily activities when compared to conventional spine surgery. 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.

Please feel free to discuss any questions you might have concerning these procedures.