This is the latest minimally invasive technique for treating patients with lumbar disc herniation. It is a percutaneous technique, done under local anesthesia by a 6 mm endoscope under c-arm control. Structures are visualized 20 times magnified on the monitor hence surgery becomes very safe. There is a good identification of structures like nerve roots, disc, epidural vessels, pll,yellow ligament, facets and their capsule and the cal sac etc.Surgery is also safe because patient is awake and he warns the surgeon immediately if his nerve root is touched, as he will experience severe pain in the leg. The surgeon keeps interacting with the patient during surgery and patient can walk on his own to his room after the procedure; just a band-aid is enough for dressing.
Micro disc surgery is the most commonly performed procedure but there are difficulties in certain situations like foraminal & extraforaminal disc, second surgery, same level and the important questions are:
- Can we avoid cutting or damaging, normal structures like ligaments, fascia, muscles, capsule, bone & facet?
- Can we further reduce the recovery time and return to work?
- What about patients declared unfit by the anesthetist?
Yes, the answer is endoscopic disc surgery, done under local anesthesia.
Indications the same as that for micro discectomy but a very careful and meticulous planning is required. Patients requiring this surgery are the ones with back pain and leg pain, confirmed clinically and by MRI, to be having disc herniation. Surgery is generally taken after failed conservative managements. This technique is called posterolateral transforaminal endoscopic discectomy done by endoscopes.
PERCUTANEOUS ENDOSCOPIC DISCECTOMY UNDER LA
Patient is awake during the surgery.