At a Glance:
1. What is a slipped, herniated disc, or lumbar disc disease?
2. What are the symptoms of herniated disc?
3. What are the causes of herniated disc?
4. How is herniated disc diagnosed by doctors?
5. What are the treatment options for herniated disc?
6. What is endoscopic spine surgery, how is it different from open surgery?
7. What is PELD, an endoscopic spine surgery?
8. What are the advantages of PELD?
9. Recovery after PELD, how long does it take?
Slipped disc or spinal disc herniation is a condition wherein the soft inner portion of the disc protrudes out through a tear in the tougher exterior. This protrusion into the spinal canal puts pressure on the spinal cord or a single spinal nerve. Technically, it is called as prolapsed intervertebral disc.
The spine or the backbone is made up of small sized, ring-shaped bones known as vertebrae. A softer jelly-like part called a vertebral disc is present within and between each vertebra acting like a shock absorber. Each disc comprises a fibrous exterior and a softer inner portion known as the nucleous pulpossus. Due to wear-and-tear or an injury, a tear in the fibrous outer part causes the soft inner portion to protrude leading to slipped, prolapsed, or herniated vertebral disc. In most of the situations, the intervertebral disc prolapses occur in the lumbar spine in the lower back and cervical spine in the neck.
Many people do not experience any symptoms from a herniated disk. However, in some persons, a herniated disk acts as a focus of irritation to the nerves in the vicinity of the affected vertebra either by direct pressure or inflammation resulting in symptoms like:
Age-related wear causes disc degeneration, making it prone to tear or rupture with slight strain or twist. Other than this, intervertebral discs can prolapse suddenly because of excessive pressure due to:
Diagnosis of a herniated disc is made by the doctor after taking a complete history of the problem followed by a relevant physical examination and investigations. The examination includes checking the back for tenderness and performing leg movements to determine the cause of pain. A neurological exam may be carried out to check:
The following tests may be undertaken as per the need:
Imaging tests:
Nerve tests:
In many cases, disc prolapse resolves on its own and symptoms disappear within 6-8 weeks or longer. The treatment options are:
Endoscopic spine surgery is an advanced surgical procedure in which the operation is carried out using an endoscope, a camera-based tube with a diameter of 8 mm. In endoscopic spine surgery, a surgeon uses an endoscope for visualization and inserts small-sized instruments through micro incisions to perform the surgery on the spine, also known as Minimally-Invasive Spine Surgery (MISS). Majority of the cases of spinal disc herniation and constriction of the spinal canal requiring surgery can be treated endoscopically.
The traditional open surgery performed under general anesthesia involves access to the surgical site through an incision that is as long as 5 to 6 inches. The surgeon has to pull the muscles aside to visualize the spine and remove the damaged part of the disc, place screws or any bone graft materials for stabilization of the spinal bones. The retraction or pulling aside of the muscle in the open surgery can potentially damage both the muscle and the adjacent soft tissue. As a result not only the recovery period is lengthier but also post-operative complications are also higher due to a larger incision and damage to soft tissues like blood loss and the risk for infection.
Endoscopic or minimally invasive spine surgery, on the other hand, reduces the extent of injury to the muscles and adjacent normal structures in the spine. Endoscopic visualization and navigation of the operative area in spine offers other advantages such as fewer complications due to smaller incisions and shorter length of stay in the hospital.
PELD (Percutaneous Endoscopic Lumbar Discectomy) is an endoscopic spine surgery to remove the slipped disc material. It is a day care procedure wherein a small incision is made through the skin without the need for cutting the bone or muscle. The procedure is performed under local anaesthesia and the patient is awake and aware of the entire procedure.
PELD is an endoscopic surgery done through percutaneous route (an incision through the skin). The surgeon makes a percutaneous incision and inserts a needle between the vertebrae and into the middle of the disc that dilates the path into the disc space. Through this dilated path, the surgeon then inserts the endoscope. Under endoscopic guidance and visualization, he removes or melts herniated disc material with the help of forceps, radio frequency probe or laser.
Full endoscopic spine surgery is the most patient-friendly procedure in which spinal herniation and bony constriction can be removed while at the same time neighboring tissues are preserved. The procedure relieves the pressure acting on the nerve, stops the inflammatory response and brings the pain to an end.
The advantages of PELD are:
A neurosurgeon will decide if you are eligible for PELD based ondisc disease and overall health of the individual. Talk to your doctor if you have the following symptoms:
Among the several factors while choosing an appropriate facility for undergoing PELD procedure, the experience and expertise of the treating surgeon are of paramount importance. Spine surgery can be carried out by Orthopaedic Surgeons or Neurosurgeons who are adequately trained in the same. In terms of infrastructure, a state-of-the-art operation theatre should include facilities for endoscopic navigation and visualization. Appropriate support services for preoperative and postoperative care including rehabilitation should be considered as well. Some factors that may be considered to assess the expertise of the treating surgeon include:
Degenerative diseases of the spine or slip disc can be managed in two ways: Conservative therapy and surgical intervention. The choice of treatment largely depends on case-to-case scenario considering the underlying medical condition and the requirements of the patient. PELD is a preffered treatment modality for herniated lumbar disc. The procedure offers better clinical outcomes compared to open discectomy sugery. With PELD, one can recover faster and safer from herniated disc diseases.
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