What is endoscopic lumbar surgery?

Endoscopic spine surgery is an alternative to conventional open microdiscectomy surgery that can be considered for certain types of herniated disc. Endoscopic surgery is a minimally invasive surgical treatment, and as such, has the advantages of reducing the manipulation of soft tissues, bone and ligament structures, which means less postoperative pain, and no destabilizing effect on the lumbar spine.

What cases is it used for?

Endoscopic surgery of the lumbar spine is indicated for certain pathologies:

Foraminal disc herniation
Extraforaminal disc herniation
Posterolateral or medial disc herniation
Foraminal stenosis
Central canal stenosis

On the other hand, this type of intervention is not recommended in case of bulky or migrated hernias, calcified, or with spondylolisthesis.

What does the procedure involve?

Lumbar endoscopic discectomy is performed through a 5-8 mm incision in the skin. Through the incision, a cannula is inserted until reaching the vertebral disc through the neural foramen (in the case of foraminal or extraforaminal hernias) or the interlaminar space (posterolateral or medial hernias), depending on the location of the hernia to be treated.

Through this same cannula, first the optical camera that allows the surgeon to view the enlarged field of work on a screen is introduced, and then, the instruments that will be used to extract the herniated disc tissue and decompress the nerve. The delicate internal tissues are constantly irrigated through the cannula throughout the surgery, which makes it possible to control or stop bleeding and dissection of the structures.

Several studies have shown that endoscopic spine surgery has the following advantages when compared to conventional surgery:

  • Less postoperative pain thanks to the lesser manipulation of tissues.
  • Less blood loss.
  • Lower risk of cerebrospinal fluid (CSF) fistula.
  • Causes no instability, as in many cases it is not necessary to remove any bone to reach the hernia.
  • Procedure is performed under local anesthesia and sedation, eliminating risks associated with general anesthesia.
  • Enables a swift return to work.

Recovery and rehabilitation after an endoscopic lumbar surgery

As it is a minimally invasive surgery, the recovery is faster when compared to traditional surgeries. The patients can get up and walk the same day of the operation, and in a large percentage of cases, they need only 1 night in the hospital.

The average recovery time is 3-6 weeks. Rehabilitation and physiotherapy are not required because there has been little manipulation of the tissues and bones during the procedure, so postoperative pain is significantly reduced. 

Risks

The possible risks and complications of endoscopic surgery are similar to those of conventional surgery. We review them below:

Immediate

Damage to neurovascular elements or to the abdominal-pelvic structures, insufficient decompression.

Short term

Dysesthesia, hematoma, infection, CSF fistula.

Long term

Reherniation or instability at the operated level.

Who are the doctors at Instituto Clavel who perform endoscopic lumbar surgery?

Dra. Varela
Dr. Català
Dr. Zabaleta

Sources

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  • Percutaneous Endoscopic Lumbar Discectomy: Indications and Complications. Pan M, Li Q, Li S, Mao H, Meng B, Zhou F, Yang H. Pain Physician. 2020 Jan;23(1):49-56.
  • How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation. Depauw PRAM, Gadjradj PS, Soria van Hoeve JS, Harhangi BS.
  • Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: A meta-analysis. Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A.
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  • A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Gibson JNA, Subramanian AS, Scott CEH. Eur Spine J. 2017 Aug;26(8):2222. doi: 10.1007/s00586-017-5112-9 
  • A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis. Kim M, Lee S, Kim HS, Park S, Shim SY, Lim DJ. Biomed Res Int. 2018 Aug 7;2018:9073460. doi: 10.1155/2018/9073460. eCollection 2018. Review.
  • Unique Complications of Percutaneous Endoscopic Lumbar Discectomy and Percutaneous Endoscopic Interlaminar Discectomy. Zhou C, Zhang G, Panchal RR, Ren X, Xiang H, Xuexiao M, Chen X, Tongtong G, Hong W, Dixson AD. Pain Physician. 2018 Mar;21(2):E105-E112.
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  • Complications of Lumbar Disc Herniation Following Full-endoscopic Interlaminar Lumbar Discectomy: A Large, Single-Center, Retrospective Study. Xie TH1, Zeng JC1, Li ZH2, Wang L1, Nie HF1, Jiang HS1, Song YM1, Kong QQ1. Pain Physician. 2017 Mar;20(3):E379-E387.

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