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Wednesday, 4 March 2015

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Improve quality of your life after Discectomy .


 

The most common surgery for lower back pain is a discectomy, which is used to treat disc herniations. It is frequently used in conjunction with other spinal procedures such as laminotomy, foraminotomy, artificial disc replacement, and other forms of spinal fusion. There are two types of discectomy techniques: traditional open discectomy and minimally invasive discectomy.

 

Why is it done?

A discectomy is performed to relieve the pressure that a herniated disc (also known as a slipped, ruptured, bulging, or prolapsed disc) places on a spinal nerve. A herniated disc occurs when some of the softer material within the disc pushes through a crack in the disk's outer lining.

 

A discectomy may be recommended by a doctor if:

 

  • Standing or walking becomes difficult due to nerve weakness.
  • After 6 to 12 weeks of conservative treatment, such as physical therapy or steroid injections, symptoms do not improve.
  • The pain spreads to the buttocks, legs, arms, or chest and becomes unbearable.

 

Indications

 

The most common reason for discectomy is a herniated disc with nerve root compression or spinal canal stenosis, which is associated with the following symptoms:

 

  • Radiculopathy is severe, and neurological deficits are progressive.
  • no response to adequate non-surgical conservative treatment
  • Cauda equina syndrome after lumbar discectomy
  • Soft disc herniations require a cervical discectomy.

 

Contraindications

 

  • Discectomy has the same contraindications as spinal surgery, which include:
  • stenosis of the bony spinal canal
  • overt segmental instability
  • Dural involvement in malignant tumors
  • neurological or vascular disorders resembling disc herniations

 

What you can expect

 

During the discectomy procedure

 

Diskectomy is typically performed under general anesthesia, so you are not awake during the procedure. Ideally, only the portion of the disc that is compressing the nerve is removed. However, in order to reach the herniated disc, small amounts of spinal bone and ligament may need to be removed.

 

If the entire disc must be removed, your surgeon may need to fill the space with bone from a deceased donor or your own pelvis, or a synthetic bone substitute. Metal instrumentation is then used to fuse the adjoining vertebrae together.

 

Following a discectomy

 

Following surgery, you are transferred to a recovery room where the medical team monitors for complications from the surgery and anesthesia. You may be able to leave the hospital on the day of surgery. However, for those with serious medical conditions, a brief hospital stay may be required.

 

You may be able to return to work in 2 to 6 weeks, depending on the amount of lifting, walking, and sitting required by your job. If your job requires heavy lifting or the use of heavy machinery, you may have to wait 6 to 8 weeks before returning to work.

 

Procedure

 

A general overview and example of various discectomy techniques are provided below 1,2. The technique may vary, particularly in certain settings such as extraforaminal discectomy.

 

Traditional open discectomy

 

  • unilateral posterior technique
  • interlaminar space exposure and incision
  • Ligamentum flavum removal after laminotomy/hemilaminectomy or without bone removal
  • Exposed discal hernia
  • confirmation of the nerve roots and gentle release
  • posterior longitudinal ligament incision at the site of maximum disc herniation
  • disc herniation resection and removal
  • Exclusion of residual herniations and confirmation of complete nerve root decompression
  • A paraspinal approach between the multifidus and longissimus muscles, as well as additional complete or partial facetectomy with or without spinal instrumentation, may be required for an extraforaminal discectomy.

 

Microendoscopic discectomy

 

  • The video monitor system 1 is used to perform microendoscopic discectomies.
  • serial dilator insertion at the affected level
  • the placement of a tubular retractor on the lamina
  • Insertion of a rigid endoscope into the retractor and video monitor setup
  • Laminotomy and ligamentum removal
  • Retraction of the nerve roots and discectomy

 

Endoscopic percutaneous discectomy

 

  • Transforaminal lumbar approach 2 (suitable for L1-2 to L4-5 intracanal disc herniation without migration):
  • Intervertebral foramen cannula insertion under fluoroscopic guidance (Hijikata's percutaneous nucleotomy technique)
  • Cannula placement under the annular outer layer via the safety triangle
  • disc fragment removal
  • Interlaminar lumbar approach number two (suitable for L5-S1 disc herniation without migration):
  • Fluoroscopic cannula insertion via interlaminar approach
  • entry point at the pedicle's medial edge, directing the cannula to the superior endplate of S1.
  • Ligamentum flavum incision and splitting
  • Using a radiofrequency coagulator to remove epidural fat
  • cannula insertion into the spinal canal
  • safeguarding the nerve roots
  • Disc herniation identification and removal
  • Anterior cervical approach 3 (herniated cervical soft discs):
  • Insertion of an intradiscal cannula through the safety zone between the carotid artery and the trachea/esophagus
  • intraoperative discography with hernia demonstration
  • serial dilution serial and endoscope insertion
  • examination of the annular fissure, the posterior longitudinal ligament, the endplates, and the herniated disc
  • Forceps selective discectomy with central nucleus preservation

 

Outcomes

 

For sciatica caused by disc herniations, discectomy can improve outcomes in the short and medium term, lasting up to four to five years. Recurrent disc herniation on the same level affects up to 9% of patients, and nearly two-thirds of them, or nearly 6%, require repeat surgery.

 

A significant disadvantage of traditional open discectomy is the extensive injury to paraspinal muscles and ligamentous structures, which causes surgical scar formation and may result in adverse postsurgical clinical outcomes or failed back surgery.

 

When compared to traditional open surgery, minimally invasive techniques result in less postoperative pain, improved postoperative recovery, or a shorter hospital stay. However, clinical outcomes do not appear to differ significantly between open discectomy and minimally invasive techniques. One disadvantage of minimally invasive techniques is the steep learning curve. In the case of extraforaminal disc herniations, micro endoscopic discectomy can reduce paraspinal muscle injury and preserve facet joints. Percutaneous endoscopic discectomy reduces nuclear volume, causing tension on the annular fibers and posterior longitudinal ligament.

 

 

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