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Lumbar Endoscopic Discectomy (LED)

 


Overview

 


What Are Lumbar Discs?

Lumbar discs are the structures which serve as shock absorbers between the vertebrae of the spinal column. The center of the disc, called the nucleus, is soft and springy and accepts the shock of standing, walking, running, etc. The outer ring of the disc, called the annulus, provides structure and strength to the disc. The annulus is comprised of a complex series of interwoven layers of fibrous tissues which hold the nucleus in place.

Lumbar Endoscopic Discectomy Surgery, Endoscopic Discectomy Center India, Lumbar Discectomy, Percutaneous Endoscopic Discectomy Surgery, Lumbar Endoscopic Discectomy Treatment, Percutaneous Endoscopic Cervical Discectomy Lumbar Endoscopic Discectomy (LED) is an outpatient surgical procedure to remove herniated disc material. An anesthesiologist provides intravenous sedation. The surgeon also uses local anesthesia. Through x-ray guidance and a video endoscope, a 3mm probe is inserted through the skin into the herniated disc. The hydrodiscectomy tool, suction and disc grasping instruments removes the herniated nucleus, resulting in pressure and pain relief on the nerve root.

Only the herniated portion of the nucleus is removed (approximately 10 – 15 %), leaving the rest of the disc intact. The disc material is then pulverized by a powerful jet of salt water which allows it to be suctioned away. The disc protrusion is decompressed in a matter of minutes. The puncture in the skin is very small (4 mm) rather than a larger incision required for open surgery.

LED is different from open lumbar disc surgery because there is no large skin incision or damage to the back muscles. Most of the complications that may occur with open surgery are eliminated with the LED procedure.


What Is LED (Lumbar Endoscopic Discectomy)?

LED is an outpatient surgical procedure to remove herniated disc material. An anesthesiologist provides intravenous sedation. The surgeon also uses local anesthesia. With the help of x-ray guidance and a video endoscope, a 3mm probe is inserted through the skin into the herniated portion of the disk. The herniated nucleus is then removed with a unique hydrodiscectomy tool, suction and disc grasping instruments, thereby relieving the pressure on the nerve root.

Lumbar Endoscopic Discectomy Surgery, Endoscopic Discectomy Center India, Lumbar Endoscopic Discectomy Treatment, Percutaneous Endoscopic Cervical Discectomy, Lumbar Discectomy, Percutaneous Endoscopic Discectomy Surgery Only the herniated portion of the nucleus is removed (approximately 10 – 15 %), leaving the rest of the disc intact. The hydrodiscectomy equipment provides a very powerful suction which draws the disc material in to the tip of the probe. The disc material is then pulverized by a powerful jet of salt water which allows it to be suctioned away. The disc protrusion is decompressed in a matter of minutes. The puncture in the skin is very small (4 mm) in comparison to larger incisions required for open surgery.

LED is different from open lumbar disc surgery because there is no large skin incision or damage to the back muscles. Most of the complications that may occur with open surgery are eliminated with the LED procedure.

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Why Is It Done?

It is done to remove a part of the patient's herniated disc which is putting pressure on the nerve roots, causing intractable pain or other severe problems.

The procedure is considered when:


  • The patient's back and leg pain does not subside after 6-12 weeks of anti-inflammatory medications and/or epidural injections with bed rest and rehabilitation.
  • A profound weakness is found in the patient's leg.
  • The patient is unable to control his/her bladder or bowels.


Indications


Who Should Consider This Procedure?

This procedure is specifically designed for patients with the disc problems accompanied by the following:


  1. Low back pain.
  2. Severe leg pain, sciatica.
  3. Pain that has not responded to conservative treatments, i.e., bed rest, analgesics, chiropractic, physical therapy and/or muscle relaxants
  4. Multiple disc protrusions may be treated at the same surgery.
  5. Herniated lumbar discs (prolapsed, protruded, ruptured and extruded) confirmed by radiologic studies that may include one or more of the following:
    • Cat Scanning
    • Magnetic Resonance Imaging
    • Enhanced CAT scan
    • Myelography
    • Discography

Contraindications


Who Should Not Consider This Procedure?

Patients who have lower back pain not caused by a herniated disc. Patients who have severe spinal stenosis (build-up of bone in the spinal canal). Mild cases of spinal stenosis associated with disc protrusions are still considered good candidates.

Only patients with clinical symptoms confirmed by physical examination and radiologic studies are considered for the LED procedure.

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The Surgery


Using x-ray guidance, a 3mm tube is advanced into the disc under x-ray control and then multiple instruments are used to remove the disc. Along with suction and a special instrument which pulverizes the disc with a safe strong jet of water, the nucleus is liquefied and easily removed. special flexible “grabbing” instruments to remove large fragments.

If the patient’s main complaint is leg pain alone or leg pain with minimal back pain, then the procedure is usually concluded at this point. Upon completion, a Band-aid is applied over the puncture site. Many patients comment that the entire procedure causes less discomfort than an epidural steroid injection. For those patients who have multiple disc problems


Advantages


The primary advantage of this procedure is that there is no interference with the muscles, bones, joints or manipulation of the nerve roots in your low back. Since the insertion of the probe does not invade the spinal canal, there is no risk of postoperative scarring of the nerves which often occurs with “open” surgery. Additionally, because the procedure is performed under intravenous sedation by an anesthesiologist as well as local anesthesia, it is much safer for the patient than that performed under a general anesthetic. Finally, because the surgery is performed on an outpatient basis, you will be discharged one hour after the surgery.

Even though many people think that laser is the most modern technique, we specifically do not use a laser to remove disc tissue. Although some lasers are presumed to be “cold”, all lasers produce heat, and we have found that in some instances the nerve root or nerve root ganglion can be injured by the heat creating a serious sympathetic pain syndrome that sometimes can be worse than the original complaint. Therefore, Lumbar Endoscopic Discectomy which is basically a water technique is much safer than the laser procedure.

Sometimes, if the patient has a significant amount of back pain, Dr. Schiffer usually encourages the patient to have a thermal annuloplasty, which takes an additional 15 minutes. The reason for this is that patients with significant low back pain have thinning of the annulus(covering of the disc). In an attempt to heal the annulus, the body responds by growing new microscopic blood vessels and nerve rootlets in the area. These tiny C fiber nerve rootlets carry the back pain impulses to the nervous system (the nerve rootlets play no part in normal sensation or movement).
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In this procedure, a metal catheter is placed in the disc under x-ray guidance and when it is properly localized, it is heated. By heating the annular fibers with a catheter, the tiny C fibers are made nonfunctional. In addition, the heat stimulates a remodeling of the annulus during the recovery phase. The heating portion of the procedure is painless. The original back painless.



Risks And Complications


As with any surgery, there are risks, including the possibility of:

  • Complications associated with anesthesia, including respiratory or cardiac malfunction. Risk of infection is low because the operating field is irrigated with water throughout the operation.
  • Paralysis; i.e., loss of use of the legs, loss of sensation and loss of control of bladder and bowels (less than 1%).
  • Temporary numbness or weakness recovered within three to four weeks (5%).
  • Recurrent herniated disc can be expected in 10 to 15% of cases (compared to 10 to 30% if operated using other procedures). This recurrence may require a repeat procedure.


Risks can be reduced by following the physician's instructions before and after surgery.



Minimal Access Spinal Technologies (MAST):


With the recent launch of Minimal Access Spinal Technologies (MAST), spine surgeons are using minimally invasive techniques for the first time to remove herniated intervertebral discs in the lumbar spine.
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Minimally invasive technologies also are allowing spine surgeons to stabilize the posterior portion of the spine by making smaller incisions that cause less damage to the elements of the spine than in an "open" posterior spinal fusion.

Potential benefits of small incisions include limited tissue disruption, enhanced visualization and illumination, shorter hospital visits and faster recovery times. MAST developments continue to promote the advancement of spinal surgery, with a focus on patient recovery and new technologies and products that could potentially provide better outcomes from surgery.



Typical Stay


Patients are normally seen in our clinic Day One, surgery is performed Day Two and on Day Three patients are once again evaluated in the clinic after which they can return home.









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