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Endoscopic Micro-Discectomy Surgery in India

 


Overview

 


Micro Discectomy In India


Through advancements in modern surgical technology surgeons worldwide have started performing a surgical procedure called a micro endoscopic discectomy (MED). The operating surgeon uses special instrumentation combined with a real-time camera display to remove a herniated disc or fragments of one through a very small incision.

Microdiscectomy Surgery in India A microscopic discectomy is performed for the same reasons as a traditional discectomy to accomplish the same results. An endoscopic microdiscectomy is performed to remove a herniated disc by using much smaller incisions. In a traditional discectomy your surgeon makes a large enough incision which he can visually see and remove herniated disc fragments. In a micro discectomy your surgeon will use small incisions combined with a small camera to locate the problematic fragment(s) and remove them with special surgical instruments. The procedure may or may not require general anesthesia and because it is done with a smaller incision there is usually less tissue damage.

There are only specific situations where an endoscopic microdiscectomy is viable. Many patients seeking surgical procedure are better suited to a traditional discectomy, or other minimally invasive surgery. Although the thought of a faster and easier recovery may sound enticing, the important thing to remember is the surgery must be performed properly.

A microdiscectomy is typically recommended for patients who have :


  • Experienced leg pain for at least six weeks
  • Not found sufficient pain relief with conservative treatment (such as oral steroids, NSAID's, and physical therapy).



MED (Micro Endoscopic Discectomy) Procedure


In most cases the patient will be “put under” with general anesthesia, but some surgeons prefer to perform a MED using either local or spinal anesthesia alleviating some patient uneasiness and concerns about general anesthesia. With the patient sedated he/she is turned onto their abdomen and secured into position with pads. A fluoroscope is used during the procedure to show live X-ray pictures on a monitor, helping the surgeon see what fragments need to be removed.
Microdiscectomy Surgery in India

Using the fluoroscope the team confirms the disc space and injects an extended duration local anesthetic through the muscle and around the bone that protects the disc. With the use of a wire and varying sizes of dilators the incision is progressively enlarged without the need to cut any muscle. It will usually take four to five dilators for the incision to enlarge to roughly the size of a nickel, which will be used as the entry point for the procedure. When the final dilator is in place, a circular retractor is placed into position to create a working channel.

Microdiscectomy Surgery in India



Once the working channel is in place all the dilators are removed. The endoscope is then attached and positioned to the edge of the channel that was just created allowing the surgeon to operate via images projected to a TV screen. The rest of the procedure is performed through the working channel.

Once the procedure is completed the wound is flushed with antibiotics. As the fluoroscope is removed your surgeon will be able to see how the tissue is coming together and place stitches to help hold the tissues together at various levels, promoting better healing.

Typically a few stitches are used on the exterior of the wound and a loose bandage is secured. After a few hours of monitoring in the recovery room, if everything goes well, the patient is allowed to leave the hospital. All that is left is for the patient to continue follow up appointments and start recovering from the procedure.


Microdiscectomy Surgery in India

Disc Materials Removal


The whole surgical procedure is performed by the surgeon looking at the television screen. Endoscopic micro discectomy claims to have produced less muscle dissection. Both these procedures (MLD and MED) are minimally invasive spine surgeries

The advantages of these procedures are : -


  • Early ambulation - patients getup and walk on the same day of the surgery.
  • Less hospital stay
  • Cosmetically acceptable - ideal for young patients
  • Less morbidity, ie. less post operative back muscle pain.
  • Handling of the neural tissues are gentle and precise due to excellent illumination and magnification.



Double Hook Retractor System


Innovation & advancement in lumbar discectomy technique

To improve the surgical has introduced a new concept in retractor system in the surgical armamentarium. Minimally invasive spine surgery is recommended for its low morbidity rate. The double hook retractor, retract lumbar paraspinal muscles against spinous process, thus obviates the limitations of single hook systems.

In Micro lumbar discectomy, an incision less than 3 cm is made between two adjacent lumbar spinous processes. Subperiosteal separation of paraspinal muscles from the spinous processes and laminae is performed. A suitable double hook retractor is selected and the hooks are placed over the lateral aspect of the adjacent spinous processes. The hooks avoid the interspinous ligament. A suitable flat blade is now introduced on the sides of the paraspinal muscles.

The parallel bars of the retractor system is now introduced in the slots available on the blades, and are distracted over a serrated bar. This maneuver now efficiently retracts the paraspinal muscle away from the spinous processes and thus providing a rectangular surgical field exposing the adjacent laminae, interlaminar space and the medial edge of the facet joint. The interspinous ligament is not disturbed.








Microdiscectomy Surgery in India

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microdiscectomy in india

 

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