Lumbar micro-discectomy or endoscopic discectomy, is performed for herniated lumbar disc that is causing pressure symptoms on the nerve roots. These usually present with leg pain or sciatica, with numbness and weakness of the foot and toes. The lumbar microdiscetomy operation is performed mostly under general anesthesia however endoscopic discectomy can be performed under local anesthesia.
The patient is placed prone and a small incision usually 3 to 5 cm long is enough to introduce an endoscope or a tubular retractor for micro discectomy. In a classical micro-discectomy no or minimal bone work is necessary (unlike the procedure of laminectomy). Only the extruded disc or the herniated part of the disc and some of the contained disc material is removed. This leaves most of the remaining disc intact. Excessive disc clearance leads to back pain which may need further surgery later.
In terms of surgery, when performed well, there is no difference between the results of endoscopic or microscopic discectomy. However, endoscopic discectomy skin incisions tend to be slightly smaller. Both surgeries involve little post – operative pain, allow early ambulation and discharge from hospital within 24 to 48 hours.
A 34-year-old female underwent L4/5 percutaneous stabilization with pedicle screws under GA for chronic back pain. Discography was suggestive of L4-L5 discogenic back pain. Five years post-op the patient is still pain free.
Pre-operative MRI showing L4-L5 disc extrusion.