What diseases of the spine can be treated with endoscopic surgery?
Herniated disc by performing endoscopic discectomy in all three areas (degrees) of the spine i.e. lumbar, cervical and thoracic spine
Spinal stenosis by performing an endoscopic foraminotomy, that is, opening the foramen that puts pressure on/entraps the nerve coming out of it
Central and Oblique Stenosis of the lumbar spine (mild to moderate degree) by endoscopic decompression – laminectomy
Discogenic Pain (lumbar/waist pain) by performing a thermal surgical remodeling of the spinal ring with a special radiofrequency device or a laser device
Facet joint syndrome (i.e. its symptom, pain) by performing endoscopic rhizotomy and lastly,
Spinal instability by performing endoscopically assisted spinal fusion.
The treatment of the above conditions with endoscopic surgery results in the treatment of:
Lumbar pain: endoscopic thermal spinal ring remodeling, assisted endoscopic spinal fusion, endoscopic rhizotomy,
Sciatica (leg pain): endoscopic discectomy, endoscopic laminectomy, endoscopic decompression,
Cervical pain (neck pain or pain in one or both hands): endoscopic discectomy, endoscopic posterior laminectomy and finally
Thoracic pain and Intercostal Neuralgia: thoracic endoscopic rhizotomy, thoracic endoscopic discectomy.
How is endoscopic spine surgery performed?
This technique is usually performed under local anesthesia and neuroleptic analgesia. For the safety of the patient’s nerve elements, the physician is in constant communication with the patient and thus can avoid the risk of injury to a nerve. Endoscopic surgery is a safe technique if performed without anesthesia. If performed under anesthesia, i.e. general anesthesia, it can become dangerous especially for inexperienced surgeons. It is performed from the sides of the spine without injuring muscles, ligaments and bone structures, as in classical techniques (open discectomy – laminectomy – microdiscectomy etc.) and is therefore considered as atraumatic and bloodless. It is radiographed with a special portable x-ray machine located in the operating room (c-arm) so that the surgeon can at any time check the position of the micro-instruments in relation to the patient’s spine, thereby ensuring accuracy and safety.
As mentioned, the endoscope transfers the image to a screen inside the operating room monitored by the surgeon. This image is enlarged, so the surgeon safely performs the surgery as the structures of the spine (nerves, intervertebral discs, ligaments, etc.) are clearly distinguished and the possibility of injury is minimized. Thus, the surgeon can remove an intervertebral disc, widen a spinal foramen, perform rhizotomy and generally all the endoscopic techniques depending on the patient’s condition, through a small incision with a diameter of 1 cm, that is, a regular surgery is performed with less risk, without destroying healthy structures. The special micro-tools that go through the endoscope are duplicates (miniatures) of all the tools used in the classic open spine surgeries except that they are thinner to go through the endoscope.
What are the possible complications of endoscopic discectomy?
Possible complications of endoscopic microdiscectomy occur during surgery or immediately after surgery.
Complication rates are about 1-3% and consist of:
- Nerve damage with accompanying tenderness, paresthesia and neuralgia
- Inadequate decompression and need for a second surgery, as there is no post-operative pain relief
- Recurrence of the intervertebral disc hernia
- Infection (discitis, wound infection, etc.)
- Extensive hematoma in the soft tissues – muscles
- Instability and spinal cord injury (to a lesser degree than classical open discectomy)
How long does the surgery last? How long does the patient stay in the clinic and when does he return to his activities?
The average surgical time required is 40 minutes. The patient’s stay in the clinic is about 3-5 hours in total, that is, a “walk in – walk out” procedure (no overnight stay is required). The patient walks immediately after being transferred to the ward, shortly after being transferred to bed. The patient can return to everyday activities on the same day or up to 3 weeks later and, depending on the type of work, the patient may return immediately for non-manual work or up to 3-6 weeks later (on average) for heavy manual work.
What are the peculiarities of endoscopic discectomy – and general endoscopic spine surgery?
These techniques require training and special equipment. Surgeon training in specialized centers abroad on endoscopic spine surgery is deemed necessary. Another major factor that plays a key role in the success of the surgery is the equipment in the operating room. There should be a suitable surgical table, specially designed for spine surgery, a suitable X-ray machine that can be combined with the surgical table, appropriate monitors, the corresponding endoscopic equipment for spinal cord surgeries with the appropriate tools, as well as experienced personnel in the operating room, that is, an experienced radiologist and an experienced assistant nurse.
Is endoscopic discectomy better than other methods?
Compared to other transdermal methods (laser, radioablation, automated transdermal discectomy) it is superior, because the aforementioned are “blind” techniques. The endoscopic technique is performed with real-time vision and the previous techniques (laser, radiofrequency) can be used in a safer way. In addition, the range of diseases that can be treated endoscopically is broader than the one that can be treated by simple transdermal techniques.
With regard to microdiscectomy, that is, the discectomy performed under a microscope, the endoscopic discectomy is not clinically predominant, although the latter does not cause spinal instability, whereas in microdiscectomy this risk is non-negligible.
As regards the cervical spine, it is assumed that endoscopic discectomy outweighs earlier techniques that involve spinal fusion, which can be avoided by using endoscopic discectomy.
What to expect post-operatively? What should I watch out for?
Most patients can go home on the same day or early on the next day.
Before leaving the hospital, a physiotherapist provides instructions on mobilization, that is, how to get out of bed and walk.
It is also recommended to avoid weight lifting, as well as bending and rotational movements for 2-4 weeks to avoid recurrence of the hernia.
Walking with gradually increased intensity is also beneficial, while seating for more than 45-60 minutes should be avoided.
Do I need to wear a back brace after surgery?
It is usually not necessary in this operation. Occasionally it may be necessary depending on the circumstances and the patient for slightly better lumbar support during the immediate postoperative phase.
How should I treat the surgical trauma post-operatively?
Most patients need no special care other than to keep the surgical trauma clean by covering it with small sterilized pad to prevent friction and irritation caused by the clothes.
When can I take a bath?
The patient can bathe immediately after surgery as long as the incision is covered with waterproof gauze so that the trauma does not get wet. After the bath the gauze must be removed, the area should dry and a small sterile pad should be applied. A normal bath can be performed after 2 weeks post-operatively and provided that the surgical trauma is fully healed.
When can I drive again?
The patient can safely drive only when the postoperative pain has fully subsided, which is usually 3 to 10 days after surgery. The patient is not allowed to drive under the influence of opioid analgesics. However, it is not advisable to make long trips for up to 2 months.
When can I get back to work and sports?
The patient may return to office work in 1 week. In sports and manual work it is safe to return in 4-6 weeks, provided that the post-operative pain has completely subsided and muscle strength has returned.
When should my surgeon see me again?
The patient should be re-examined in 10 days after surgery. The doctor will inspect the surgical incision and examine the patient.
What are the success rates of this procedure?
The outcome of these surgeries is usually excellent with total pain relief immediately after surgery. The success rates are approximately 95%.
Most patients report immediate improvement and return to their work and daily life without any problems.
When should I choose MIS microdiscectomy instead of endoscopic microdiscectomy?
MIS microdiscectomy is the procedure indicated in patients with intervertebral disc herniation with concomitant pain and/or neurological deficits (paralysis, hyposensitivity, etc.) and is the type of surgery applied for definitive treatment of the lumbar disc herniation.