A new way to treat chronic back pain

The extreme pain of a herniated disc can be difficult to live with, but a new, minimally invasive spinal-surgery technique called an endoscopic discectomy is increasingly providing relief to South African patients.

Traditionally, disc herniations are treated with open discectomy surgery, but endoscopic discectomy offers a valuable alternative. It has many advantages, including that it doesn’t traumatise your spine the way open surgery does. ‘In fact, you’ll come away with a less than 1cm cut and just one dissolvable stitch, and should be able to walk within an hour of the operation,’ says Dr Riaan Jacobs, an orthopaedic and spinal surgeon at Life Bay View Private Hospital in Mossel Bay, Western Cape.

Here’s all you need to know about this innovative procedure.

What is endoscopic discectomy surgery?

During surgery, an endoscope – a long, thin, flexible tube 5–6mm in diameter that has a light source and tiny camera on one end – is inserted through a small incision in your back so that images of the disc damage can be assessed on a TV monitor by a surgeon. ‘With special instruments, we then remove the problematic disc, with the least amount of damage or trauma to the surrounding tissue and structures,’ explains Dr Jacobs.

How does it differ from traditional spinal surgery?

  • It’s minimally invasive. Traditional surgery has larger incisions and involves the detachment of muscles and other tissues, spinal fusions and implants, for example. Endoscopic surgery only uses a small incision and there’s no disruption of the muscles, or a spinal fusion or implants.
  • Local anaesthetic and sedation are used. ‘Patients are awake enough to let their surgeon know if, for example, the surgeon is touching a nerve – this is called intraoperative patient nerve monitoring,’ explains Dr Jacobs. ‘This fact does put some people off, but patients generally have amnesia of the procedure, as they’re barely awake. However, if patients prefer, a general anaesthetic can be administered.’
  • Shorter duration. Generally, it takes only an hour if all goes according to plan.
  • Reduced post-operative pain. ‘The pain level pre-operation is 10 out of 10, but an hour after the operation, it’s often 0 or 1 out of 10. An hour after the procedure, you get a patient to walk to the bathroom, and then they can go home,’ says Dr Jacobs.
  • Shorter hospital stay. It can be performed as a day or overnight procedure, unlike traditional surgery, which sees patients hospitalised for much longer.
  • There are fewer complications when compared to traditional surgery, for example bleeding and infection.
  • Earlier return to work. ‘Some patients have gone back to work after only 3 days following their endoscopic back operation, although a recovery period of 2 to 4 weeks is advised,’ says Dr Jacobs. Traditional surgery advises 2–6 weeks.
  • Relatively easy revision surgery in the future, if needed, because of minimal scar formation. ‘With traditional surgery, you always get hard scar tissue. If, for example, another herniation occurs, then a surgeon has to fight against this scar tissue. But with endoscopic surgery, there are hardly any signs of scar tissue,’ says Dr Jacobs.

Who is an ideal candidate for this surgery?

Not all disc herniations can be treated with endoscopic surgery. ‘The ideal candidate is someone who has experienced acute back and leg pain for a short duration. It must be a fresh injury several days or weeks old, that is, not someone who’s been walking around for months with a herniated disc,’ explains Dr Jacobs. ‘It’s also a safer option for older patients who are too sick to have open surgery.’

What diagnostic tests have to be done to determine a candidate’s suitability?

‘Other than blood tests to determine whether a patient is fit for surgery, the main diagnostic test used is a magnetic resonance imaging (MRI) scan. X-rays alone don’t show the disc itself, whereas an MRI does,’ explains Dr Jacobs.

How safe is endoscopic back surgery?

This is a spinal operation where surgeons work close to, and on, the nerves, cautions Dr Jacobs. ‘There’s definitely not a 0% chance of nerve injury, but compared to traditional surgery, the risk is smaller for nerve injury, as well as infection and bleeding.’ The main precaution you need to take is stopping any medication that makes you prone to bleeding – for example, Aspirin or blood-thinning medication like Warfarin – at an appropriate time before surgery, he advises.

WORDS BY CARLA HÜSSELMANN

The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE.

References:

  • Adapted from Life Healthcare magazine. (2018). 6 Things You Need to Know About Endoscopic Back Surgery by Hüsselmann, C. p.38. Adapted with permission.
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