Minimally Invasive Discectomy

Definition
Minimally invasive discectomy (cervical, lumbar or thoracic spine) is a spine surgical technique causing minimal trauma to the superficial structures of the spine (i.e., skin, muscles and ligaments).

Indications
The surgery can be done for herniated disc or synovial cyst causing nerve root compression in the cervical or lumbar, or thoracic spine.

Procedure
The surgery is performed under general anesthesia, typically in the prone position (facedown). A small skin incision (less than 1 inch) is made, then sequential dilator tubes are passed through the tissues and muscles of the spine down to the surface of the spine. Next, a hollow tubular retractor, 18mm to 20mm in diameter, is passed through the dilated path down to the surface of the spine. Spine surgery proceeds to open the spinal canal for removal of the herniated disc or synovial cyst. Minimally invasive surgery requires special surgical instruments designed to work down the narrow tubular retractor. Visualization down the tube can be with an operating microscope, a camera mounted in the tube or an endoscope. Otherwise, the surgery proceeds as a typical open discectomy to remove the herniated disc or synovial cyst to relieve pressure on the nerve root for relief of arm or leg pain, numbness or weakness.

Postoperative course
This procedure is usually performed as a day surgery or a one-night hospital stay.

Advantages
Since such a small incision is made, there is minimal incisional pain and minimal muscle spasm postoperatively. The length of stay is shorter than open discectomy. Resumption of usual activities, such as driving, work and other physical activities tends to be earlier than open discectomy.

Complications
Risks are basically the same as open surgery and include infection, hemorrhage, spinal fluid leak and nerve injury. The risk of all these is very low for this procedure.

The procedure usually has a high success rate, and most patients are quite gratified with their relief of pain, numbness or weakness. 


To view the animation Micro Endoscopic Discectomy, click here.

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