An endoscopic discectomy, also called a microendoscopic discectomy (MED), is a minimally invasive surgery in which herniated disc material is removed. A herniated disc occurs when one of the discs that separate and cushion the vertebrae of the spine, usually but not necessarily in the lumbar region, bulges or rips. This may also be called a ruptured disc or a slipped disc and is usually caused by the combination of age and chronic strain on the back. A herniated disc may present symptoms of aching at the site of the rupture that gets aggravated during physical stress, sciatica, leg numbness and loss of bowel and bladder control in severe cases, and in some cases, no symptoms at all.
After diagnosing a herniated disc, a doctor will prescribe physical therapy and lifestyle changes to most patients, but some cases will require an endoscopic discectomy. Surgery is considered for patients who don’t respond to non-surgical treatment or have abnormal weakness, numbness, or pain. Before ordering surgery, a doctor will conduct tests such as magnetic resonance imaging (MRI) or computed tomography (CT) to rule out any other causes, determine the severity of the ruptured disc, and ensure that it is safe to operate. If the patient has cauda equina syndrome, in which the patient’s ruptured disc is placing pressure on the cauda equina nerves, causing loss of bowel control and numbness, the case is considered a medical emergency and the patient will be scheduled for surgery.
An endoscopic discectomy is a minimally invasive approach to herniated disc surgery. The procedure usually requires only a local anesthesia, so that the patient stays conscious throughout the surgery. The surgeon will make a half inch to one inch (1.3-2.5cm) long incision in the back at the site of the slipped disc and insert a wire through the incision to the spine. Instead of cutting the muscles, dilators are pushed into the back along the wire to stretch the muscles into a one inch (2.5cm) circular opening. A retractor is then implanted to hold the muscles open for the procedure.
The surgeon then inserts a hollow endoscope into the back between the vertebrae that sandwich the ruptured disc. An endoscope is a flexible or rigid tube with a lighted viewing device that transmits the image to a fiberscope or screen so that the doctor can see inside the body without conducting open surgery. The surgeon then inserts instruments through the hollow tube and makes a small opening through the muscle and bone to access the disc. The disc fragments are then removed and the in tact part of the disc is left to heal on its own. The incision will be dressed with antibiotics and may require one or two stitches or none at all.
The patient can expect the endoscopic discectomy to take roughly an hour, depending on the size of the patient and the nature of the ruptured disc. The patient should experience little to no pain following the procedure and will likely be able to check out of the hospital within hours. Though an endoscopic discectomy has a faster recovery period than open discectomies, it is not preferable in all cases. A doctor will determine which type of surgery is appropriate for each case.
