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.

Your back needs your help

Around 80% of adults suffer from back pain at some point in their lives. Before it becomes a chronic condition, there are things you can do to keep it in good shape. Read on for our round-up of preventative measures. 

According to Mayo Clinic, there are various conditions that are linked to back pain. It often develops without a specific cause that can be identified with a test or imaging study, and could result from:

  • A sudden fall
  • Muscle or ligament strain due to repeated heavy lifting or a sudden, awkward movement
  • Bulging or ruptured discs in your spinal column
  • Arthritis
  • Skeletal irregularities such as severe scoliosis
  • Brittle and porous bones from osteoporosis

It is possible to reduce your risk of chronic back pain by using proper body mechanics and keeping your body, particularly your back, in a healthy condition.

Tips for positive lifestyle changes

  1. Maintain a healthy weight. Additional weight places strain on your back muscles, which could lead to back pain. Stay fit and healthy and maintain a good body weight with a balanced diet and regular exercise.
  2. Exercise. Do low-impact exercise, build up your core and include strength training into your regime. Low-impact sports such as swimming, walking and cycling are effective for staying fit. Consider core-focused activities such as yoga and pilates to strengthen your back muscles and give your spine the support it needs for daily activities.
  3. Build flexibility. Staying in the same position for extended periods of time is bad for your back. Relieve the pressure by getting out of your chair, walking and doing simple stretches. Try a quick routine of bending forward, then back, then side to side.
  4. Lighten your load. Health.com suggests that if your handbag, backpack or briefcase is more than 10% of your bodyweight, it’s too heavy. Think about lightening a little of the load and switching sides every 20 minutes.

Use the correct body mechanics

  1. Lifting heavy objects. Bend at your knees, keep your back straight, squat down and look straight ahead. Take care not to twist when you lift and keep the object close to your body. Activate your stomach muscles and use your legs and knees to lift.
  2. Digging in your garden. Hinge at your hips with your lower back flat or slightly hollow so that your hips rather than back take the strain.
  3. Carrying items. Maintain your balance by not carrying too many items at the same time. Try to equalise the weight on both sides of your body, for example, place equally weighted shopping bags in both hands instead of just one. Make multiple trips if needed.
  4. Posture. Stand up straight with your ears lining up with your shoulders, shoulders with hip joints and hip joints with ankles. Sit in a chair with good lower-back support, or place a rolled towel or pillow in the small of your back to keep its natural curve. Knees should be at hip level and you should change your position every 30 minutes.

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

References:


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