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Endoscopic spinal surgery: a single-incision, single-hole procedure.
Therefore, this article will help us understand the different endoscopic surgical methods for herniated discs and how these techniques can help treat spinal conditions.
Understanding the location of a herniated disc.
In most cases, a herniated or ruptured intervertebral disc occurs in four locations:
1. Central Herniation (Middle Intervertebral Disc Herniation)
A herniated disc in the middle of the vertebrae compresses the nerves in the spinal canal, particularly in the posterior part of the spinal cord. This often results in bilateral sciatica (back pain radiating down both legs) and, if the compression is severe, may cause urinary or fecal incontinence.
2. Paracentral Herniation (Middle Intervertebral Disc Herniation)
A herniated disc in a medial (slightly lateral) position compresses a nerve in the nearby spinal canal. This is a common type and usually causes radiating back pain down one leg (sciatica).
3. Foraminal or Lateral Herniation (lateral intervertebral disc herniation)
A herniated disc protrudes to the side of the spinal canal and compresses the nerves exiting the spinal cord in the foramen. This is another common location and often causes pain and numbness in one leg or hip if the disc compresses the lateral nerve.
4. Extraforaminal Herniation (Intervertebral disc herniation outside the nerve canal)
A herniated disc protrudes more than normal outside the spinal canal, compressing nerves located outside the canal. This is most common at the L3-L4 or L4-L5 level and causes severe pain in the leg or hip.
At S Spine Hospital, most patients with herniated or ruptured intervertebral discs are found closer to the medial and lateral sections of the spine, rather than outside the spinal canal. This is due to the thinning of the intervertebral disc structure in the posterior medial section, vertical weight-bearing pressure, and the location of the spinal nerves.
📚 What are the symptoms of "Herniated Nucleus Pulposus"?
Learn about PELD and PSLD endoscopic surgical techniques.
PELD and PSLD endoscopic spinal surgery have different methods and efficiencies, as detailed below:
1. Percutaneous Endoscopic Lumbar Discectomy (PELD)
It is suitable for treating uncomplicated disc conditions, i.e., discs that are herniated or ruptured and compressing nerves on the outer side of the spine.
The doctor will make an incision laterally through the nerve canal (transforaminal or extraforaminal approach) to remove the herniated disc that is compressing the nerve.
This technique has limitations: it cannot be used in cases of highly complex conditions because lateral biopsy cannot reach herniated or ruptured intervertebral discs in the center or near the midline of the spinal canal, and it is not possible to visualize the nerves or spinal cord that are being compressed by the disc.
2. Percutaneous Stenoscopic Lumbar Decompression (PSLD) surgery.
This is the latest technology used in the treatment of spinal stenosis and deep, complex nerve compression, specifically treating herniated or ruptured intervertebral discs in the medial, near-medial, and lateral areas of the spine that are compressing the nerves.
The doctor will make an incision in the back of the spine, through the interlaminar approach, to widen the narrowed spinal canal. This allows for precise access to the area needing treatment and enables clear visualization of any disc compression affecting the nerve.
However, it is crucial that the PSLD technique requires highly specialized physicians due to the complex nature of the surgical site. A skilled support team is essential to ensure effective treatment, helping to reduce surgical time, and state-of-the-art specialized equipment is needed to achieve the best possible results.
📚 Both involve microscopy, but different types of microscopes are used.
📚 PSLD: The latest innovation in back pain treatment – minimally invasive, safe, and using cutting-edge technology.
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