Minimally Invasive Endoscopic Spine Surgery A new ray of hope

In this age of the computer, lower back pain and Slip Disc are a common problem. In many cases of slip disc, surgery is an obvious choice, but conservative open surgery is not always fruitful. In these cases, the new treatment Minimally Invasive Endoscopic Spine Surgery is a real solution. Surgical treatment of  Degenerative Disc Disease has evolved from traditional Open Spine Surgery to Minimally Invasive Spine Surgery including Endoscopic Spine Surgery.  The advantages of Endoscopic Spine Surgeries are, less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring; reduced hospital stay, early functional recovery and improvement in the quality of life. Dr. Gautam Das, a renowned Pain Management Specialist, Daradia Pain Hospital, Kolkata, shares his valuable knowledge about Slip Disc and the latest surgical treatment.

The discs, in healthy individuals, act as shock-absorbers during various movements of the body, and also help in the movement of the trunk.  Sometimes, one or more of the intervertebral discs and the outer annulus get ruptured, and can no longer hold the inner nucleus pulposus. This causes the nucleus pulposus to come out, leading to irritation of the nerve roots or inducing pressure over nerve roots. The ruptured annulus fibrosus with nucleus pulposus coming out is known as a Slip Disc or Disc Bulge or Prolapsed Disc.

This should be treated conservatively, initially. Sometimes, conservative management is not effective enough. Untreated Slip Disc can have serious effects such as weakness or paralysis. Conventionally two types of surgeries are available to treat Prolapsed Disc, which include open discectomy and micro-discectomy.

Both procedures have the same principle at their core, i.e. to remove the part of the disc which is causing irritation or pressure on the nerve roots. The only difference is the approach of the surgery and its associated short-comings.

Dr. Gautam Das said, “Open discectomy is done under general anesthesia, where an incision about 5-6 cm for one level discectomy is done to visualize the affected disc. Muscles and ligaments need to be incised or sometimes dissected to visualize the disc. Once the affected disc and adjacent lamina (part of vertebrae) are visualized, the affected part of the disc is removed. After that, layer by layer the closure is done, by suturing the skin. Post surgery patients have to be kept under supervision for at least 3-4 days. However, this approach is associated with various side effects and complications. It may include the risk of bleeding, infection, injury to nerve roots, injury to meninges (Dural tear), embolism and post-operative pain due to large tissue damage.”

He further adds, “To tackle this problem, an advanced surgical technique like micro-discectomy is introduced. The surgery is done with the help of a microscope. This technique needs a smaller incision, usually 2-3 cm, and it is associated with lesser post-operative pain, reduced hospital stay (typically 1-2 days) and less incidence of side effects and complications. But, like open discectomy, it also needs general anaesthesia”.

The most recent type of surgery used is endoscopic discectomy. Technically it is the most advanced surgery with the least side effects. In this technique, the endoscope is inserted by making a very small skin incision, typically 0.2 cm to 1.2 cm. It gives a highly magnified view of the disc with the help of a camera attached to the endoscope. A very small instrument is introduced to the affected part of the disc and it is removed in small pieces. This is done under local anaesthesia, and there is no need for general anaesthesia unlike the above two approaches. As the tissue damage is very minimal, risk of infection, post-operative pain, bleeding, and other complications are also very minimal. Moreover, the patient can be discharged on the same day of surgery and costs of surgery are reduced to a great extent. Thus for Slip Disc, the world is moving towards Endoscopic Surgery.

For Appointement : Dr. Gautam Das, Pain Management Specialist, Daradia Pain Hospital, Kolkata