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Lumbar Endoscopic Discectomy
Lumbar Endoscopic Discectomy: LED (Microdecompressive lumbar discectomy)
What are Lumbar Discs? Lumbar discs are the structures which serve as shock absorbers
between the vertebrae of the spinal column. The center of the disc,
called the nucleus, is soft and springy and accepts the shock of
standing, walking, running, etc. The outer ring of the disc, called
the annulus, provides structure and strength to the disc. The annulus
is comprised of a complex series of interwoven layers of fibrous
tissues which hold the nucleus in place.
Herniated discs are often called a "slipped disk". This term was derived from the
action of the nuclear tissue when it is forced from the center of
the disc. The disc itself does not slip. However, the nuclear tissue located
in the center of the disc can be placed under so much pressure
that it can cause the annulus to herniate or rupture. When the
disc has herniated or ruptured, it may create pressure against one or
more of the spinal nerves which can cause pain, weakness or numbness
in the lower back, leg or foot (sciatica). Other common names for a herniated
disc are "protruded disk" and " ruptured disk". Herniated disc surgeons can treat slipped disks with the procedures below.
Treatments for Herniated Lumbar Discs Depending
upon the results of the physical and radiologic examinations and
the severity of your condition, your doctor may offer you
two forms of treatment. The first common treatment prescribed for lower
back pain caused by the herniated lumbar disc is conservative therapy.
Conservative therapy may consist of a period of bed rest, analgesics,
chiropractic, physical therapy and/or muscle relaxants.
However, if after therapy the pain has not been relieved, a surgical
procedure may be considered. My philosophy is to do the least invasive
surgical procedure which combines the least surgical risk with
the greatest opportunity for success. Outpatient procedures are
also less costly.
What is LED (Lumbar Endoscopic Discectomy)?
LED is an outpatient surgical procedure to remove herniated disc
material. An anesthesiologist provides intravenous sedation. The
surgeon also uses local anesthesia. With the help of x-ray guidance
and a video endoscope, a 3mm probe is inserted
through the skin into the herniated
portion of the disk.
The herniated nucleus is then removed with a unique hydrodiscectomy
tool, suction and disc grasping instruments, thereby relieving
the pressure on the nerve root. Only the herniated portion
of the nucleus is removed (approximately 10 – 15 %), leaving
the rest of the disc intact. The hydrodiscectomy equipment
provides a very powerful suction which draws the disc material
in to the tip of the probe. The disc material is then pulverized
by a powerful jet of salt water which allows it to be suctioned
away. The disc protrusion is decompressed in a matter of
minutes. The puncture in the skin is very small (4 mm) in comparison
to larger incisions required for open surgery.
LED is different from open lumbar disc surgery because there
is no large skin incision or damage to the back muscles. Most of
the complications that may occur with open surgery are eliminated
with the LED procedure.
Indications: Who Should Consider This Procedure? This procedure is specifically designed for patients
with the disc problems accompanied by the following:
Low back pain.
Severe leg pain, sciatica.
Pain that has not responded to conservative treatments, i.e.,
bed rest, analgesics, chiropractic, physical therapy and/or muscle
Multiple disc protrusions may be treated at the same surgery.
Herniated lumbar discs (prolapsed, protruded, ruptured and extruded) confirmed by radiologic studies that may include one or more of the following:
Magnetic Resonance Imaging
Enhanced CAT scan
Contraindications: Who Should Not Consider This Procedure?
Patients who have lower back pain not caused by a herniated disc. Patients who have severe spinal stenosis (build-up of bone in the spinal canal). Mild cases of spinal stenosis associated with disc protrusions are still considered good candidates.
Only patients with clinical symptoms confirmed by physical examination and radiologic studies are considered for the LED procedure.
The Surgery The procedure is performed in a hospital or an outpatient
surgery center under conscious sedation by an anesthesiologist
as well as local anesthesia administered by Dr. Schiffer. Using
x-ray guidance, a 3mm tube is advanced into the disc under x-ray
control and then multiple instruments are used to remove the disc.
Along with suction and a special instrument which pulverizes the
disc with a safe strong jet of water, the nucleus is liquefied
and easily removed. Dr. Schiffer is able to decompress the disc
protrusion in a matter of less than 5 minutes. He also has special
flexible ?grabbing? instruments to remove large fragments. If the
patient?s main complaint is leg pain alone or leg pain with minimal
back pain, then the procedure is usually concluded at this point.
Upon completion, a Band-aid is applied over the puncture site.
Many patients comment that the entire procedure causes less discomfort
than an epidural steroid injection. For those patients who have
multiple disc problems, Dr.Schiffer is unique in that he operates
up to four disc levels in one surgery.
Postoperative Course Most patients feel immediate relief from pain following
the procedure. Walking is permitted the same day and patients are
discharged from the surgical center in one hour. Some patients
experience lower back muscle spasms that may last a few days following
the procedure. This pain can be relieved with muscle relaxants
and analgesics, heat and light massage, if needed.
Advantages The primary advantage of this procedure is that there
is no interference with the muscles, bones, joints or manipulation
of the nerve roots in your low back. Since the insertion of the
probe does not invade the spinal canal, there is no risk of postoperative
scarring of the nerves which often occurs with “open” surgery. Additionally,
because the procedure is performed under intravenous sedation by
an anesthesiologist as well as local anesthesia, it is much safer
for the patient than that performed under a general anesthetic.
Finally, because the surgery is performed on an outpatient basis,
you will be discharged one hour after the surgery.
Even though many people think that laser is the most modern technique,
we specifically do not use a laser to remove disc tissue. Although
some lasers are presumed to be “cold”, all lasers produce
heat, and we have found that in some instances the nerve root or
nerve root ganglion can be injured by the heat creating a serious
sympathetic pain syndrome that sometimes can be worse than the
original complaint. Therefore, Lumbar Endoscopic Discectomy which
is basically a water technique is much safer than the laser procedure.
Sometimes, if the patient has a significant amount of back pain,
Dr. Schiffer usually encourages the patient to have a thermal annuloplasty,
which takes an additional 15 minutes. The reason for this is that
patients with significant low back pain have thinning of the annulus(covering
of the disc). In an attempt to heal the annulus, the body responds
by growing new microscopic blood vessels and nerve rootlets in
the area. These tiny C fiber nerve rootlets carry the back pain
impulses to the nervous system (the nerve rootlets play no part
in normal sensation or movement). In this procedure, a metal catheter
is placed in the disc under x-ray guidance and when it is properly
localized, it is heated. By heating the annular fibers with
a catheter, the tiny C fibers are made nonfunctional. In addition,
the heat stimulates a remodeling of the annulus during the recovery
phase. The heating portion of the procedure is painless. The
original back painless.
Typical Stay Patients are normally seen in our clinic Day One, surgery
is performed Day Two and on Day Three patients are once again evaluated
in the clinic after which they can return home.
Summary Clinical results with Lumbar Endoscopic Discectomy, over
the past 4 years have demonstrated:
Excellent success rates
The structure of the disk is still
Serious complications are very rare
Faster return to work and normal activity; and because there
is no hospitalization, significant cost savings
For more information about Lumbar Endoscopic Discectomy, please contact