Disc herniation and lateral spinal stenosis are two conditions that can lead to severe back pain for many people. Sometimes the pain is temporary and is easily resolved with conservative treatments, such as rest, anti-inflammatory medications, steroidal injections, and rehabilitation. However, for others, the pain can be excruciating and long lasting, regardless of what is done to correct the problem.
Advances in surgical techniques and medical instrument technology have brought on vast improvements in the treatment of these spinal conditions. This guide describes two new and exciting procedures available at the Bumrungrad Spine Institute. They are the least invasive spine surgeries to date to remove a portion of a herniated lumbar disc or decompress a constricted nerve root in lateral stenosis.
What is Endoscopic Spine Surgery?
The back is comprised of many interlocking bones, discs, ligaments, tendons and nerves, and sometimes it can be difficult to identify a single cause of back pain. When a specific cause is identified, it usually stems from an abnormality that is quite small. With traditional spine surgeries, sometimes healthy body tissues must be cut and large incisions are required to obtain the visibility needed to correct the problem. Endoscopic spine surgery addresses this challenge by using an endoscope, an instrument that acts as an eye inside the patient’s back, to see and correct the faulty structures while avoiding extensive tissue damage.
The Endoscope: "Smaller than your finger"
This is a small, tubular medical instrument that uses light and water to visualize a patient’s spine from the inside out. The lens of the scope is shaped at an angle that allows the surgeon to clearly see abnormalities around and under the physical structures of the back. Other medical instruments are inserted through the endoscope, so only one 7.9 mm incision is needed.
Benefits of Endoscopic Surgery Include:
- Very small incisions
- Reduced recovery and rehabilitation time
- Less pain
- Decreased risk of infection
- Minimal damage to surrounding, healthy tissues
- Lower cost
Conditions that Endoscopic Surgery Can Help
Disc herniation is a condition where the shock-absorbing disc located between the vertebrae bulges out from its normal position due to a tear within the disc. The bulged portion can place pressure on the spinal nerve roots. Symptoms can vary in their severity depending on how far the disc displaces and whether the disc remains intact or ruptures.
Lateral spinal stenosis is a condition where the passageway of a spinal nerve along the side of a vertebra is narrowed. When this occurs, the smaller passage can constrict or irritate the nerve.
Both conditions can lead to any of the following symptoms:
- Localized back pain
- Sharp, shooting pain in the lower back or leg
- Weakness, numbness or tingling down the leg
- Endoscopic discectomy is done to remove the portion of a patient’s herniated disc that is actually causing the patient discomfort. The entire procedure takes approximately 30 minutes and patients can walk immediately after the surgery.
- Endoscopic lateral decompression is performed to reduce the compression of spinal nerve roots located inside constricted passageways along the back sides of vertebrae. In this procedure, the surgeon removes a portion of the joint and ligament which is the source of the compression. Similar to endoscopic discectomy, the entire procedure takes approximately 45 minutes and patients can walk immediately after the surgery.
Who is a Candidate for Endoscopic Spine Procedures?
Generally, endoscopic spinal surgeries are only considered in cases where:
- 6 -12 weeks of conservative treatment have failed
- The patient exhibits profound leg weakness
- There is a loss of bowel and bladder control
Asian Full Endospine Training Center
The team at the Bumrungrad Spine Institute is led by a neurosurgeon and orthopedic surgeon who were trained by the German pioneer of endoscopic spine procedures, Dr. Sebastian Ruetten. We have performed over 300 endoscopic surgeries in Thailand, with 95% excellent or good results.
The Institute has become a recognized regional authority on spinal problems and treatment, as demonstrated by the establishment of the Asian Full Endospine Training Center. This center conducts regular workshops where Bumrungrad’s specialists help train spine surgeons from around the world in the latest endoscopic treatments.
You can see images of the surgery in the following video:
Bumrungrad International Clinic (BIC) Building , 20th floor
Bumrungrad International Hospital, Bangkok, Thailand
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