Endoscopic Lumbar Discectomy

The world’s most tissue preserving disc surgery

If severe pain and neurological symptoms cannot be controlled by conservative care a surgical intervention will be necessary. The aim of the discectomy is to remove the extruded disk tissue and to decompress or to completely set free the pinched nerve.

We carry out all disk surgeries endoscopically. No large incisions or opening of the spinal canal is necessary with this procedure. It is therefore, a tissue-preserving alternative to the conventional “open” surgery. As there is almost no tissue destruction, risk of scarring is very low. Additionally, the intervention is much less cumbersome. Altogether the healing process is accelerated and recovery times are much shorter.

Do you suffer from back pain?

Minimally invasive = gentle and safe

The new endoscopic discectomy technique allows us to treat a herniated disk more safely and in a more tissue-preserving way than ever. The most important difference to a conventional endoscopic procedure is the lateral access through the foramen compared to the traditional dorsal access. By this method, the nerves that run through the spinal canal remain completely untouched and injuries, adhesions and other complications are henceforth avoided. An added benefit is that the intervertebral ligaments that stabilize the spinal column remain intact.

As the lateral access allows for a ”tissue-preserving procedure” which is generally associated with relatively little pain; no general anesthesia is required.

How is endoscopic disk surgery carried out?

Under local anesthesia an optical endoscope is inserted through a small incision in the skin. It is equipped with tiny working cameras and is carefully pushed forward to the site of the disk prolapse. The extruded disk tissue can be removed under sight control. Protruding remainders are eliminated by means of a special laser nucleolyser. In certain cases, the gel-like nucleus of the intervertebral disk is shrunk with the aid of chymopapain – a special protein-cleaving enzyme. This helps to disencumber the fibrous ring in order to aid the subsequent healing process. For the revitalization of the spinal disk, abrasion of the calcified vertebral bone by means of minute instruments is done. This leads to a better blood supply in the disk tissue and a firm and stable fibrous ring can develop.

The intervention takes between 30 to 45 minutes. The entrance point is aseptically covered with a small patch.

Patients are subsequently monitored for 2 hours in the recovery room. In good cleans general conditions, out-patient surgery is possible.

The day after the intervention and then after a three month period, there will be follow-up examinations.
Not all endoscopic surgeries are the same!

The big difference between our surgery technique and other endoscopic surgeries – which is also its main advantage – is the point of entrance. Whereas in our clinic the herniated disk is accessed laterally other techniques enter from the back. The lateral transforaminal access is much more tissue-preserving than the dorsal access as it leaves the nerves and ligaments unhurt and can be performed under local anesthesia.

Most other endoscopic disc surgery techniques also use the transforaminal access (lateral opening for nerve exit), however the primary target is the disc itself. By removing healthy disc tissue a volume loss is created (vacuum). This shall lead to a retraction of the prolapsed tissue back into the disk space with an associated decompression of the pinched spinal nerve. In many cases this is successful. Procedures with a similar philosophy are; for example, the tissue shrinkage with laser chomucleolysis, injections of alcohol or suction of disc tissue. Success rates of these procedures are rather low and are associated with a risk to accelerated degeneration and instability.

With the dorsal entrance point, the ligamentum flavum must always be “sacrificed” and the nerves must be retracted to one side. This is associated with a considerable risk of injury. Further more the intervention has to be carried out under general anesthesia – otherwise patients could not tolerate the pain.

What postoperative care is necessary?

There will be a follow-up examination the day after the intervention. Additionally a physiotherapist will propose an individually targeted rehabilitation program. During the first two weeks you will have to put on a specially fitted plastic corset, which sustains your back and will soon allow for resuming daily activities. It is recommended to start a professionally supervised physiotherapy after one week. After 6 weeks, strengthening exercises for your back and abdominal muscles should be started.

When may I resume my sports activities after my endoscopic discectomy?

After about three weeks you should be able to go swimming or to ride your bicycle. You may resume your usual sports activities after 6 weeks.

When can I go back to work after my endoscopic discectomy?

After one to two weeks you can resume simple office work and slight physical work. You shouldn’t do any hard physical work during the first 6 weeks and then only gradually increase.

What is the success rate of endoscopic discectomy?

International scientific literature quotes success rates of about 90%. In our own statistical evaluations for endoscopic discectomy we found a success rate of 95%.

All advantages of endoscopic discectomy at a glance:

• Very high success rate > 95%
• Very low infection rate < 0,01%
• The intervention can be carried out under local anesthesia – no general anesthesia is required!
• In most cases patients are pain free immediately after surgery!
• As there is almost no tissue damage, the intervention is much less cumbersome and the risk of complications is very low
• No instability, as the structures that stabilize the spine – the ligaments and joints – remain unhurt. This is the main difference with microscopic surgery technique.
• Less wound healing pain as well as higher stability as back muscles are not cut or torn.
• Little infection risk, as access is through a small cutaneous incision (5mm).
• Less scarring in the region of the nerve roots!
• Two hours after the intervention you will be able to walk without pain.
• A short hospital stay. You can go back home the day after the intervention
• After a few days you may resume your usual daily activities.
• Short recovery times. After one or two weeks you can go back to work, after 6 weeks you may resume your usual sports activities.
• Little scarring