Endoscopic techniques for diagnostic purposes have been in use since the late 1970s. The endoscopic surgery techniques that became widely used in the 1990s for other surgery disciplines are now available for the treatment of spine conditions.
Using special instrumentation and video cameras, spine surgeons can now perform surgery through small incisions.
Endoscopic spine surgery is a Keyhole surgery of the spine. It is used to treat disc prolapse, disc bulges, sequestrated disc and canal stenosis of the spine.
The human spine consists of bony blocks called 'vertebrae' which are stacked one on top of the other. The intervening space has an intervertebral disc, which consists of a jelly-like internal material called 'nucleus pulposus' and a fibrous external covering called 'annulus fibrosus'.
Certain conditions cause the external covering to tear, leading the internal jelly-like nucleic fluid to leak into the spinal canal which comprises of the spinal cord.
The conditions which lead to this are mostly poor posture, sudden loading of the spine, injuries, smoking, being overweight and poor fitness.
Patients who have suffered from a slipped disc, experience a sharp pain in the back associated with a catch, bent posture or sciatica (shooting pain going into the legs). This is a common illness which is estimated for over 40% of adults. Fortunately, the majority of the patients recover and become pain-free.
Patients who do not recover from this pain in four months, have an exponential increase of pain or have a neurological deficit in the form of numbness/weakness of the lower limb and bladder bowel disturbance, will need immediate surgery.
A traditional disc surgery would consist of removing the posterior 1/3rd of the vertebrae (laminectomy) to access the disc. This results in prolonged recovery and de-stabilizing the spine which may eventually call for a second surgery in 15% of the operated patients.
An endoscopic discectomy achieves the same without disturbing the posterior part of the vertebrae. The advantages are lesser post-operative pain, faster recovery and less chance of failures. The spine surgeons at ZOI, Hyderabad, have been performing these procedures since the last 15 years.
In an endoscopic discectomy, the patient is anaesthetised, made to lie prone on the operating room and a small incision of 2-3 cms is made. A cannula is inserted under fluoro guidance up till the spine. Through this cannula, one camera and two surgical instruments are inserted. The prolapsed loose disc is identified and excised.
The procedure takes about 45- 60 minutes and then the patient is discharged either on the same day or the next day.
The normal recovery process varies from 1-3 months based on patient's general health and weight. Most patients are made to walk on the same evening and are discharged the next day. Patients are encouraged to walk, perform their daily routine from the 2nd day onwards. Oral medications for pain, muscle relaxants and neurotonic drugs may be prescribed for a few weeks.
The recovery post endoscopic discectomy is very rapid compared to a laminectomy. Patients are permitted to walk, climb stairs and take part in activities which do not entail lifting weights, bending and floor sitting from the 2nd day onwards. Sitting at a desk and working is best avoided for a couple of weeks.
We advise patients to avoid sitting continuously for more than 45 minutes at a stretch, patients who are desirous of going back to work are permitted to do so with these precautions.
Driving a 4-wheeler for short distances is permitted based on the level of back pain and discomfort. However 2 wheeler driving is strictly prohibited for a minimum of 4 weeks.
At Zoi we do not advise exercises under the guidance of physical rehab specialist for the first 3 weeks. These 3 weeks gentle exercises are taught and the patient is encouraged to perform these by him/her self without a therapist.
Most patients are advised to undergo intensive therapy under the supervision of a physiotherapist from the 4th week onwards for 1-3 weeks.
The intention is to regain full fitness and get back to physical activity. Post completion of this, patients are permitted to perform floor sitting, 2-wheeler driving and playing sports.