A Guide to Endoscopic Disc Surgery

What is an Endoscopic Discectomy? This minimally-invasive procedure is performed through a tubular device. It is designed to relieve pain caused by herniated discs pressing on nerve roots. This surgery is performed on an outpatient basis, which allows the patient to leave our Citrus Park Surgery Center the same day.

‍How long does an endoscopic discectomy take? Endoscopic discectomy usually takes 45 minutes and is performed in our Citrus Park Surgery Center. Patients can expect to go home same day. However, it may take longer if you have scar tissue from previous surgeries or certain other factors.

When can I return to work following an endoscopic disc surgery? The overall lumbar discectomy recovery time is approximately 4 to 6 weeks, but you may be feeling back to normal well before that time. Patients can return to light work 1 week after surgery and heavy duty work 4-6 weeks following the procedure. ‍ However, every patient is different and our board-certified spine surgeon will work with you to determine how your specific lumbar endoscopic discectomy recovery time should progress.

Do all herniated discs require surgery? The short answer is no. The majority of herniated discs do not require surgery. However, a very small percentage of people with herniated, degenerated discs may experience symptomatic or severe low back pain, which significantly affects daily life.

What is the success rate of endoscopic discectomy? A published 2016 study aimed to present long-term results from a 10-year follow-up after endoscopic lumbar discectomy presented the following results:

Outcomes were excellent in 17 patients (80.95%), good in 3 (14.28%) and fair in 1 (4.78%), with no patients having a poor result.

Overall, the success rate of this type of procedure is usually 90 percent or higher, however there are chances for complications, which include dural tears, nerve root damage, bladder incontinence or bleeding. Most of the time, however, the operation is safe, effective, and rarely results in recurrent herniated discs. (source: medical daily)

What is the difference between open disc surgery and endoscopic disc surgery? Endoscopic disc surgery has several advantages over traditional open disc surgery. In an open procedure, there is a midline incision and muscle is dissected off the bone. Then, small amounts of bone are removed to expose the affected nerves. The nerves are moved aside to get to the disk herniation which is then removed with small grasping instruments. The nerves are gently moved back into place and the wound is closed in multiple layers.

What is the difference between open disc surgery and endoscopic disc surgery? Endoscopic disc surgery has several advantages over traditional open disc surgery. In an open procedure, there is a midline incision and muscle is dissected off the bone. Then, small amounts of bone are removed to expose the affected nerves. The nerves are moved aside to get to the disk herniation which is then removed with small grasping instruments. The nerves are gently moved back into place and the wound is closed in multiple layers.

In endoscopic disc surgery, a small 3mm incision is made and the muscles moved aside with dilators. The disk herniation is approached through a small canula and visualized using an endoscope. Minimal bone is removed to give the affected nerve more free space. The disk herniation is removed under direct visualization and the small wound is closed with a few sutures and small band aids. Other than having a small incision, there are real medical advantages to having an endoscopic discectomy over an open discectomy.

What are the advantages to endoscopic disc surgery? Less Blood Loss: There is very minimal blood loss with endoscopic surgery in comparison to an open procedure, but neither has significant blood loss. However, bleeding around a nerve root can cause scarring and pain, so the less blood loss, the better.

Less scarring: The body heals by scar tissue, so scarring by itself is not a bad thing. There is a smaller skin incision with endoscopic surgery, so there may be a cosmetic reason to do endoscopic disc surgery but usually this is not a major consideration for most patients. But painful nerve scarring can be a big problem that is difficult to treat. It is not very common with open disc surgery, but it is much less common with endoscopic surgery.

Less trauma to muscles: There is significantly more muscle trauma with open disc surgery that causes additional pain and more time to rehabilitate. And the muscles of the spine dissected will never be completely normal. Endoscopic disc surgery has much less muscle trauma and the muscles affected are more on the side which are less involved with back extension and standing up straight. Endoscopic disc surgery often requires little or no rehabilitation in most patients, which allows faster return to function and work.

Shorter hospital stay: Both endoscopic disc surgery and open discectomy can be done as an outpatient. But with less muscle trauma and bleeding it is easier to perform endoscopic disc surgery as an outpatient and it is more likely that the patient can go home after minimal recovery time. And because of the smaller incision, the patient will not typically need IV narcotic medication which would require a hospital stay. Patients usually go home with a short course of oral pain medication.

Quicker recovery time: Because of the small incision, less muscle dissection and less pain, the patients who have endoscopic disc surgery typically recover much faster than open discectomy patients.

In most categories The endoscopic discectomy is the better choice.

Watch the Lumbar Endoscopic Discectomy Procedure Video Here

When is open discectomy typically the better choice for disc herniation surgery?

1. In revision disc surgery: When the patient has been operated on before and there is significant scar tissue. It may be difficult to get the job done with a lot of scar tissue and abnormal anatomy with an endoscopic discectomy.
2. When there are other problems that need surgical treatment: Such as many arthritic spurs that need a more complete decompression than can be achieved through a small focused approach.
3. When there is a large extruded herniation that is “floating around” and needs to be seeked out. It is much easier with an open incision so that your surgeon can be sure to find it and get it all.