Minimally Invasive Discectomy
When patients have chronic leg pain due to a herniated disc, a surgical procedure called a discectomy may be necessary. At the San Diego Center for Spinal Disorders (SDCSD), we will usually consider a discectomy if a patient has had combinations of severe leg pain and numbness or weakness lasting more than twelve weeks despite conservative management. Our skilled surgeons can perform minimally invasive discectomies when appropriate, which can result in less pain and quicker recovery for the patient.
In this article, you can learn what a disc is, what happens during a discectomy and the benefits of a minimally invasive technique.
What is a disc?
Discs, which act as shock absorbers for the spine, are located in between each of the vertebrae in the spine. Each disc contains cartilage in a tire-like outer band (called the annulus fibrosus) that surrounds a very firm but gel-like cartilage substance (called the nucleus pulposus).
A herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases a chemical that can cause irritation to the surrounding nerves causing inflammation and pain.
Discectomy - the procedure
To relieve nerve pressure and pain, surgery usually involves removing the displaced part of the damaged disc. This is called a discectomy. In order to gain access to the nerve in the spinal canal and to the offending disc fragment, a small opening (or laminotomy) is made in the outer bony covering of the lumbar spine called the lamina. This is done with a small burr or micro-sized punch. The disc fragment itself is removed with micro instruments. In this manner, the nerve is freed of pressure. In rare instances, such as with recurrent disc herniations, and only if necessary, the space left by the removed disc will be filled with a bone graft - a small piece of bone usually taken from the patient's hip. The bone graft is used to join or fuse the vertebrae together. This is called a fusion. In some cases, some instrumentation (such as plates or screws) may be used to help promote fusion and to add stability to the spine.
Traditionally, a discectomy for a herniated disc is performed through a two-inch incision in the patient's back. The muscle is peeled off of the surrounding lamina bone in order to access the disc space. While this gives the surgeon access to the disc space, it does cause some muscle damage and prolong recovery time.
We perform endoscopic discectomy surgeries, which utilize minimally invasive techniques. Minimally invasive surgery uses smaller incisions and specialized instruments such as microscopes and endoscopes.
The overall goal of the endoscopic technique is similar to that of an open discectomy. However, we use various endoscopic systems, which allow us to place a thin tube through a small incision in the skin. A specialized micro video camera, or a microscope and specialized lighting, is used to visualize the nerves and disc. Removal of disc material is performed with specialized micro instruments.
The biggest advantages of this procedure are that none of the muscles, ligaments, or other soft tissue structures needs to be cut or disrupted in any significant way. This translates into decreased pain after surgery and an enhanced rate of recovery. This technique can often be done on an outpatient basis. Many patients can return to work in just a few days.
This technique is only appropriate for certain types of disc herniations and is not as appropriate for revision surgeries.