Before we can understand what a discectomy is and how the procedure works there is one part of the spinal anatomy you should become aware of. The intervertebral disc is a structure that is located between each of our spinal vertebrae. It has two functions; spacer and shock absorber. If you picture a jelly donut it will give you a clearer understanding of the structure itself; it has a soft gel like material called the nucleus pulposus and a tough exterior skin holding it together called the annulus fibrosus.
When an intervertebral disc’s nucleus pulposus (the center of the disc) becomes damaged to the point where conservative treatment methods fail to offer the patient sufficient relief, a discectomy may be performed to remove it. A damaged nucleus pulposus causes pain by placing excessive strain and/or pressure on the spinal cord or exiting nerves. Advancements in the medical field have made is so this surgery can be performed microscopically or endoscopically and the advanced procedures have been named microdiscectomy and endoscopic discectomy respectively.
Endoscopic Discectomy – The Procedure:
Once sedated through intravenous medicine the patient is brought to the operating room. Under local anesthesia and with the aid of x-ray guidance a small metal tube the size of a pencil is inserted into the patient. Looking through the camera the surgeon will easily be able to find the damaged disc. Larger pieces of damaged disc will be pulled out with the use of a grabber, while smaller disc bulges or tears can be treated with a laser to vaporize the disc material and deaden the pain nerves inside the disc. The disc is then hardened to prevent further leakage of the disc material to the surrounding nerves.
The only major difference between a cervical endoscopic discectomy and one that is performed in the lumbar region is how access is gained for the camera. During a cervical endoscopic discectomy access is gained from the front of the neck while during a lumbar procedure access is gained from the lower back.
Microdiscectomy – The Procedure:
The surgeon gains access to the spine through a small incision in the center of the back. The incision is about an inch to an inch and a half in length. The surgeon will then lift the back muscles away from the lamina gaining access to the ligamentum flavum which he will then cut away. With the use of a microscope or operating glasses the surgeon will then be able to visualize the affected nerve, lifting it out of the way while he cleans the debris from the area.