Minimally Invasive spine surgery in India - (Percutaneous Endoscopic Lumbar Discectomy)

A percutaneous discectomy is a surgical procedure in which the central portion of an intervertebral disc is accessed and removed through a cannula. The percutaneous surgical procedure is for safe and sparing excision of herniated disc material. Even sequestered disc material - regardless of its size and level - that slipped into the spinal channel can be removed with this minimal invasive method.

The discectomy is performed through a cannula inserted through the back into the center of the vertebral disc under local anesthetic using a stylet. After the position of the stylet is confirmed to be correct using AP and Lateral X-ray views it is removed leaving the cannula in place. The disc material may be removed using surgical tools such as the Dekompressor or traditional manual surgical tools, however the manual instruments require a larger cannula and more disruption to the surrounding structures. Both the automated and manual percutaneous discectomy procedures produce similar results and reduction in disc height and pressure on the nerves to result in pain reduction.

What does the procedure involve?

Percutaneous Endoscopic Lumbar Discectomy is a minimal invasive spine surgery. It is an endoscopic surgical procedure which is conducted under local anaesthesia with mild sedation. The patient is made to lie on his/her front and the exact entry point is mapped on patient’s body using image intensifier X-ray system. A small incision of about 8-10 cm is made from the midline on the posterior part of the body. There are two different ways in which the inter-vertebral disc material can be removed:

•            Manual procedure also known as Automated Percutaneous Discectomy involves insertion of a long spinal needle from the side of the back, directly into the disc, by-passing other bone and ligaments. Through this needle, guide wire is passed and after making a 5 mm incision, a dilator and working cannula are passed, through which an endoscope is inserted. The prolapsed part of disc is removed with the guidance of the camera and monitor attached to the endoscope.

•            The laser surgery, referred to as Percutaneous Laser Discectomy (PLD), uses an external imager called the fluoroscope to direct the probe. The probe delivers laser energy which vaporizes a part of the inter-vertebral disc material and decompresses the nerve root. The most frequently used laser for treatment is Holmium Yttrium-Aluminum-Garnet (YAG) laser.

Advantaages of PELD (Percutaneous Endoscopic 

Lumbar Discectomy)

• ·         Surgery done under local anesthesia with conscious sedation
• ·         Very good technique for old and medically compromised patients.
• ·         No muscle, ligament or normal tissue damage
• ·         It saves the time and the costs. 75% of the patients discharged on the same.
• ·         Due to rapid recovery, comparing to open surgeries, it is recommendable for the workers or students with the desire of early return-to-work.
• ·         Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.
• ·         Very good technique for old and medically compromised patients.
• ·         Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.

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