A microdiscectomy is also sometimes referred to as a microendoscopic discectomy. This is a less invasive version of open discectomy surgery and is used in the majority of patients receiving partial disc removal operations. Obviously, a minimally invasive version of any operation is always preferred to a full open technique, since it is less risky, less damaging to healthy tissue and easier to recover from.
This essay will provide a summary of the microendoscopic discectomy procedure. We will examine why the procedure is used and the results which are typically demonstrated after surgery.
What is Discectomy?
This endoscopic type of spinal surgery encompasses many procedural variations, but all seek to remove a portion of a bulging disc thought to be compressing a spinal nerve root or impinging on the spinal cord. There are countless varieties of this operation, but all demonstrate minimally invasive surgical techniques using the latest high tech equipment to reduce trauma to the patient.
Microendoscopic procedures are a better choice for most patients, since they eliminate much of the agony and injury associated with full open herniated disc surgery and they also demonstrate better curative results than their fully open counterparts. During the procedure, the surgeon removes the bulging section of the intervertebral disc, taking pressure off the affected nerve and allowing the disc to return to a more typical shape and size.
Minimally invasive partial disc removal procedures are most often used to treat herniated discs diagnosed as causing particular nerve compression syndromes. This is a very common diagnosis, but actually occurs quite infrequently.
In order for a disc to actually compress a nerve, it would literally have to cover the entire neuroforaminal opening under substantial pressure. This seldom occurs and even if the disc touches the nerve tissue, it rarely has any noticeable effects, unless obvious compression is enacted. This might help to explain the relatively poor curative results of discectomy techniques, and back surgery, in general.
Misdiagnosis is a huge problem within the back pain industry, with many scapegoat conditions accepting the blame for pain without any semblance of a verified pathological process taking place.
Discectomy is also used when discs are theorized to enact central spinal stenosis. In these circumstances, a herniation will rarely be the sole source of symptomatic canal narrowing, but may be in some extreme cases. Far more often, the herniation exists with the addition of another structural issue, such as arthritic debris or ligamentum flavum hypertrophy. Combined, these may create a symptomatic stenosis issue. In these instances, additional procedures may be combined with discectomy for best curative results.
I definitely recommend a microendoscopic version of the discectomy over any full open operation. However, treatment statistics for all variations of discectomy are poor when viewed over several years postoperatively. Additionally, over 95% of these disc removal procedures are unnecessary, yet are still performed on countless patients every year. It should be a crime. Even with successful operations, there is a great risk of spinal disc re-herniation or pain moving to a new location.
There are far better non-surgical options which offer better curative results, such as spinal decompression therapy. Of course, that is assuming that the diagnosis of an actual pinched nerve or spinal stenosis event is correct, which should never be taken for granted.
For patients who really do need surgery, it may be wise to consider even less damaging and drastic choices. Intradiscal electrothermy and nucleoplasty are both options for patients with documented herniations which are proven to enact nerve interaction. While neither is perfect, these techniques might be better suited for many patients, when compared to discectomy.