Endoscopy – Endoscopic Lumbar Discectomy

Endoscopy - Endoscopic Lumbar Discectomy

The only discectomy surgical intervention in the world with parallel preservation of the anatomical structure.

Dr. Stylianos N. Kapetanakis
Orthopedic and Spine Surgeon MD, FRCS, PhD Priv. Consultant Spine Surgeon Ass. Professor at Medical School of Democritus University of Thrace

Endoscopic Lumbar Discectomy

The only discectomy surgical intervention in the world with parallel preservation of the anatomical structure.

If the intense pain or the neurological symptoms cannot be conservatively treated then surgical restoration is necessary. The purpose of discectomy is disc material removing and decompression or complete release of the nerve.

Endoscopy on the other side demands a very small incision (8 mm) from a far lateral position without being necessary to open the spinal canal. It constitutes hence an alternative solution of anatomical structure preservation in contrast to conventional “open” surgical operation. The risk of scars or complications appearance is very low since there is almost not at all tissue damage. In total the healing process is accelerated and the rehabilitation times become considerably smaller.

Why endoscopic discectomy is the most gentle and safe method?

Endoscopic discectomy allows us to treat disc hernia in a higher security framework parallely with more tissue preservation. The most important difference with a conventional endoscopic procedure is the lateral approach approximately 12 cm from the middle line through the foramen and the fact that local anesthesia is applied. We enter laterally and do not cut in the middle patient’s back. By this way nerves which lie in the spinal canal remain intact and nerves’ injuries, adhesions and other complications are avoided. Furthermore muscles, bone and intervertebral ligaments which stabilize intervertebral column remain intact.

Pain is significantly less and general anesthesia is not essential, advantages that are attributed to the fact that lateral access allows tissue preservation.

How is endoscopy performed?

An optical endoscope is inserted through a small skin incision under local anesthesia. It is equipped with small cannulas and pushed carefully in front of the side of disc prolapse. The extruded disc material can be under optical control removed. The protruding residues are removed with suitable forceps and a special nucleolyser laser. That contributes to nerve decompression and we have thus immediate relief of the patient.

The intervention lasts 30 to 45 minutes. The entry point is aseptically with a small piece covered and then the aperture is by a suture closed.

Patients are subsequently for 2 hours into a recovery room monitored, leaving hospital the same or the next day.

All endoscopic surgical interventions are not the same!

The fundamental difference from the other endoscopic operations –which also constitutes the major advantage-, is the entry point. Other techniques enter from the back in disc hernia. The lateral transforaminal access is much more conservative concerning the tissue in comparison with the posterior access since nerves and ligaments remain intact and local anesthesia can by applied.

The result depends largely in surgeon’s experience.

Most endoscopic discectomy techniques use the transforaminal access (lateral open for nerve exit). The primary target is, however, the disc himself. The remove of healthy disc material results in volume loss (blank). That will lead to recall of disc tissue prolapse back in the empty space and to decompression of the spinal nerve. This is in many cases successful. Procedures with similar philosophy are for example tissue shrinkage with laser, chomucleolysis, alcohol injections or disc tissue suction. The success rates of these techniques are rather low and are connected with risk of degeneration and increased instability.

The technique that Dr. Kapetanakis in Interbalkan Medical Center uses aims to the direct and safe removal of the hernia that compresses the nerve- independently from its localization or its size. Physical condition of the disc as well as the mobility and stability of the operated vertebral column part are fully maintained.


What is the postoperative care?

There will be a monitoring examination a day after the operation. Furthermore, a physiotherapist will explain you a particularly targeted rehabilitation program. During the first two weeks a specially equipped plastic corset must be placed. This corset will support your back, allowing you parallely soon to do your daily activities. It is recommended to start physiotherapies after a week. After 6 weeks you must begin strengthening exercises for your back and the abdominal muscles. You can simultaneously and gradually continue your sport activities.

When can I repeat my sport activities after my endoscopic discectomy?

After approximately three weeks you will be able to go for swimming or cycling. You can return in your usual sport activities after 6 weeks.

When can I return at work?

After from one to two weeks –and maybe earlier- you can continue simple office works and light physical work. You should not do any hard physical work during the first 6 weeks. You can subsequently increase it gradually.

What is the success rate of endoscopic discectomy?

Success rates depend largely on surgeon’s experience. In international scientific bibliography success rates are of 95%. Our statistical evaluation for endoscopic discectomy revealed a success rate of 97%.

All advantages of endoscopic discectomy at a glance:

  • Extremely high success rate >95%
  • Very low contamination rate <0.01%
  • The intervention is conducted under local anesthesia- general anesthesia is not required!
  • In the majority of cases patients feel no pain directly after the surgical operation!
  • Complications risk is significantly low since there is almost none tissue damage.
  • Instability is absent because the anatomical structures which stabilize vertebral column –ligaments and joints- remain intact. This is the basic difference in comparison with microscopic discectomy.
  • Less wound healing pain as well as more stability since back muscles are not cut.
  • Low contamination risk because access requires only a very small skin incision (8 mm)
  • Less scars in nerve roots region!
  • Patient is able to walk without pain already two hours after the operation.
  • Brief hospital stay: you can go back to home the day after the operation.
  • Already after some days you will be able to continue your usual daily activities.
  • Short rehabilitation times: you can go back to job after one or two weeks whereas you can continue your sport activities after 6 weeks.
  • Small scars.
The patient is under general anesthesia. Risk of nerve damage from surgery
The operation is performed under local anesthesia and simultaneous sedation. The patient is under constant supervision. Nerve damage is therefore kept to a minimum.
The patient is in a prone position and the surgery is performed through an incision of 4-8 cm in the back of the spine.
Endoscopic surgery is performed through a very small incision 7 mm just sideways.
The risk of recurrence is about 10 to 17%. There is a high probability of scarring around the nerves. There is also a high risk of the healthy disc tissue being damaged or removed.
There is very little scar tissue growth. Only the disc prolapse is removed. The risk of recurrence is about 4%.
The pain is relatively severe after surgery.
No or minimal pain.
Return to full activity after 6 weeks.
Two hours after the operation the patient can leave the recovery unit alone
1 to 3 weeks. Introduction one day before surgery.
Some hours
The posterior muscular system must be detached from the bones of the affected part, parts of the bone, and the ligaments must be removed or cut - loss of stability and trauma, as a result, lead to constant pain.
The surgeon removes only the annoying part of the disc tissue without destroying or removing the surrounding structures such as bones, ligaments or muscles or the rest of the normal disc. Therefore, instability or the development of scar tissue around the nerve is prevented.
Return to sports activities 4-6 weeks.
Return after 1-2 weeks.
Long waiting times are not unusual.
In acute cases you can be operated on within 48 hours.

We are always by the patient's side

You can contact us by email or by calling us to investigate the causes of the difficulty you are experiencing.

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