Endoscopic spine surgery

Endoscopic disc surgery / endoscopic spine surgery

Endoscopic spine surgery is a closed percutaneous method which has started a new age of slipped disc treatment. This gentle, comfortable and revolutionary treatment is used to cure many kinds of herniated discs and chronic back pain. It can even be increasingly employed to remove a stenosis of the nerve root canal (so-called foraminal stenosis). Important prior to endoscopic disc surgery is a reliable diagnosis poving which disc causes the complaints. This diagnostic foundation can be achieved, for example, by using MRI (at Beta Klinik we use an open MRI system with 1.5 T) or discography.

Without any damage of muscles and ligaments, almost every slipped disc in lumbar spine can be treated with endoscopic spine surgery. Instead of exposing the spine with an open surgery access, natural, osseous openings of the spine are used for the insertion of the endoscope. This is possible because the instrument has only a diameter of 7 mm.

Illustrations A-C explain the endoscopic disc surgery. The herniated disc compresses nerve tissue and causes complaints like pain or neurological deficits (A). The disc herniation is gently removed by minute instruments through a small endoscope (B). As a result, the nerve tissue is no longer compressed but relaxed, and, thus, the complaints decrease.

Our special endoscopic spine surgery technique

The advantage of our endoscopic spine surgery technique in comparison to others:

We use the safely lateral access that is easy on tissue. Additionally, we use a very gentle anesthesia that is well-tolerated.

The removal of the herniated material is performed via the safe and gentle lateral access – passing nerves and the posterior ligament (ligamentum flavum) and navigating through the nerve root canal.

Most surgeons practicing endoscopic surgery use the endoscopically more difficult and risky posterior access and destroy the protecting ligament (ligamentum flavum). Nerve roots have to be moved to navigate to the slipped disc, but that increases the risk of damage. This kind of surgery necessitates the use of general anaesthesia because pain would be unbearable. In contrast, endoscopic surgery can be done in local anaesthesia and analgosedation.

Our endoscopic method is a very appropriate method even for the removal of recurring slipped discs because the choice of the lateral access does not irritate existing scar tissue.

During endoscopic spine surgery, the patient lays in a comfortable lateral position. After skin desinfection and the calculation of the surgical access, a needle is put to the region to be operated (upper left image). Using X-ray control enables the exact placement of the needle (upper right image). This needle is necessary for the placement of the endoscope. Through the endoscope, special instrument, for example, gripping pliers, are inserted in order to remove the disc herniation (lower left image). A control of what the surgeon does is possible at any time in real time with the help of a camera inside the endoscope transmitting it signal to monitors (lower right image). A specific laser shrinks protroding residues. In special cases, the core of the disc (nucleus pulposus) is shrinked with the aid of a specific enzyme to reduce the stress of the exterior cartilage ring (anulus fibrosus) and to heal the disc. To induce the revitalization of the disc, the calcified end plate of the adjoining vertebral bodies is perforated by minute instruments. This improves the circulation of the disc, allows the migration of stem cells from bone marrow into disc space and helps to build a solid and stable tissue similar to the original cartilage.

Because endoscopic spine surgery is a closed low-risk method, very rarely, there occur complications, or pain or scars remain. Usually, patients can leave the hospital the following day. Younger patients can even undergo surgery as outpatients.

Below you can see an animation of the endoscopic spine surgery showing the course of the operation. The small inserted windows in the upper right corner display the image section the surgeon also looks at during endoscopic spine surgery. The video details a removal of a herniated disc in lumbar spine. You can see the several steps of the operation in which different wires, tubes, endoscopic drills and pliers are used to remove the herniated disc tissue. The result of the endoscopic disc surgery in the animation is the complete removal of the herniated disc tissue that pressed onto the spinal canal and, thus, caused complaints.

We thank maxmorespine very much for allowing us to embed their video. Please press the play button and wait a moment. Subject to the speed of your internet connection, it can take a while until the animation of the endoscopic spine surgery starts.

Advantages of endoscopic spine surgery

Often Patients are free of pain directly and able to walk 2 hours after endoscopic spine surgery. They can go home the same day or one day after the operation. A quick return to occupational and sports activities after endoscopic spine surgery is possible. Because of the lateral endoscopic approach, it is easy on tissue and muscles and, thus, also usable in case of recurrent disc herniations since scar tissue is not irritated. Endoscopic spine surgery is even usable to cure nerve root stenosis (foraminal stenosis) and disc wear and tear accompanied by chronic back pain. Here are the advantages of endoscopic spine surgery in short:

• often painless directly after surgery
• painless walking possible only 2 hours after surgery
• patients can go home on the same day or only one day after surgery
• quick return to occupational and sports activities
• it is easy on tissue and muscles
• even usable to cure recurrent slipped discs because the scar tissue is not irritated due to the lateral access
• even usable to cure nerve root stenosis (foraminal stenosis) and disc wear accompanied by chronic pain

Aftercare and Rehabilitation of endoscopic spine surgery

One day after endoscopic disc surgery, there is a follow-up examination and a consultation with a physiotherapist about individual postsurgical rehabilitation measures. Usually, the guided physiotherapy programme can start one week after surgery. Riding a bike or swimming is possible 2 weeks after the operation. A return to sports and fitness training is possible 4-6 weeks after endoscopic surgery.

Return to Work after endoscopic spine surgery

Only one week after endoscopic surgery – in single cases only a few days after surgery – office work can be resumed. Heavy manual work should be shortened within first 4-6 weeks and can slowly be raised afterwards.

Return to Sports after endoscopic spine surgery

All sports activities can be performed a certain period after endoscopic disc surgery. Whereas swimming and biking are permitted only after 2-3 weeks, other sports activities can be started slowly raising after 4-6 weeks.

Safety and Success Rate of endoscopic spine surgery

In the last few years, the success rate of endoscopic spine surgery has been increased above 95%. The same result holds for microscopic surgery. The high degree of safety and the high success rates result from technical optimization, improvement of instruments and the long-term experience of surgeons.

Further endoscopic disc surgery methods

For more information about endoscopic abrasion, please click here.