Open Back Surgery Vs. Minimally Invasive Spine Surgery

By: Robert Langard

How is an open discectomy performed?
An open discectomy is performed under general anesthesia. The procedure takes about an hour or so, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.
In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Then using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.
Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

What is the recovery from a discectomy?
Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.
Gentle activities are encouraged after surgery, such as sitting upright and walking. Patient must avoid lifting heavy objects, and should try not to bend or twist the back excessively. Patients should avoid strenuous activity or exercise until cleared by their doctor.

What are the potential complications of discectomy?
The most common problem of a discectomy is that there is a chance that another fragment of disc will herniate and cause similar symptoms down the road. This is a so-called recurrent disc herniation, and the risk of this occurring is about 10-15%.
Most patients find relief of much, if not all, of their symptoms from a discectomy. However, the success of the procedure is about 85-90%, meaning that 10% of patients who undergo a discectomy will still have persistent symptoms. Patients who have symptoms for long periods of time, or severe neurologic deficits (such as significant weakness) are at higher risk of incomplete recovery.
Other risks of surgery include spinal fluid leaks, bleeding, and infection. All of these can usually be treated, but may require a longer hospitalization or additional surgery

percutaneous arthroscopic laser discectomy

A percutaneous arthroscopic laser discectomy is done when the patient's history, physical examination and imaging (such as CT scan or MRI) indicates herniated or bulging disc and the material inside the disc has not ruptured into the spinal canal. There also may be signs of serious nerve damage in the leg, severe weakness, loss of coordination and/or loss of feeling. Anyone with any significant bony anomalies or foraminal stenosis would not be a candidate for a percutaneous arthroscopic laser discectomy, but would benefit from a Foraminotomy procedure.

When a traditional percutaneous arthroscopic laser discectomy is performed, the surgeon uses X-ray monitoring and fiber optics resulting in pictures displayed on a monitor similar to a TV screen, therefore allowing the surgeon to see what is compressing the nerve during the procedure and remove it with laser, ensuring a much higher rate of success. A percutaneous arthroscopic laser discectomy can be performed without the need for general anesthesia in an outpatient surgical setting.

After a local anesthetic is administered, a small incision is made and a round Depuy tube is put into the incision This tube allows the surgeon to perform percutaneous arthroscopic laser discectomies with minimal damage to the surrounding muscles. The muscles are pushed out of the way and are not torn or cut.

The laser, camera, suction, irrigation and other surgical instruments are inserted through this working tube. Once everything is in place, the surgeon utilizes a laser to vaporize the disc material, therefore diminishing the pressure on the spinal cord and/or the spinal nerve. Many patients feel immediate relief during the percutaneous arthroscopic laser discectomy as the pressure is minimized. When the procedure is complete, the tube is slowly removed, allowing the muscles to move back into place.

A percutaneous arthroscopic laser discectomy is a relatively short procedure, only taking ? hour to 45 minutes to perform with a quick recovery ensured afterwards. After 1-2 hours of monitoring, the patient (with a companion) is free to go. Patients are generally encouraged to take a long walk the afternoon or evening of their percutaneous arthroscopic laser discectomy procedure.
Advantages for having Percutaneous Arthroscopic Discectomy:
&bullOutpatient procedure - no hospitalization
&bullNo general anesthesia
&bullNo arthrodesis (fusion)
&bullMinimally invasive
&bullVery successful
&bullShort recuperation - quickly return to normal activities
Minimal scar tissue formation

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