Unveiling the Best Surgical Option for Herniated Discs — Microdiscectomy vs. Endoscopic Discectomy

BY JOSHUA ABRAMS, DO

 

Joshua Abrams is a fellowship-trained and board-certified orthopedic spine surgeon who employs new cutting-edge techniques to minimize post-surgical pain and optimize patients’ experience.

 

View Bio

 

 

 

 

 

Up to 80% of people will experience back pain at some point in their lives, and herniated discs are frequently the culprit. This problem can cause intense discomfort. Imagine a jelly-filled doughnut squishing out its filling, and you have a rudimentary idea of what’s happening. 

Discs absorb shocks between the vertebrae in your spine. However, when they herniate, they can press on nearby nerves, causing a spectrum of symptoms that range from dull aches to debilitating pain, tingling and even muscle weakness. 

Fortunately, there are surgical options available to relieve the pain caused by herniated discs. Two common surgical approaches for this condition are microdiscectomy and endoscopic discectomy. In this blog post, we’ll compare these two procedures to help you decide which one might be right for you.

Comparing the Two Surgical Options

Living with the debilitating pain of a herniated disc can feel like an endless battle. Simple tasks become daunting challenges, and the prospect of returning to a pain-free life can seem like a distant dream. When deciding to have surgery for a herniated disc, you must weigh various factors to make the best choice for your well-being.

Microdiscectomy — The Gold Standard

Microdiscectomy may provide the relief you seek if you’ve reached a point where conservative treatments do not succeed. This surgical procedure, often hailed as the gold standard for addressing herniated discs, offers the promise of relief and recovery. What is it, how does it work and what can you expect from this time-tested solution? Let’s look at how microdiscectomy can be the key to unlocking the shackles of herniated disc pain.

• Proven effectiveness: Microdiscectomy has a long track record of 90% success and high patient satisfaction rates, making it the top recommendation of many surgeons. 
• Precision and clarity: Microdiscectomy is a time-tested, traditional surgical procedure that offers surgeons a clear, direct view of the surgical area. The high level of visualization allows for precise removal of the herniated disc material, minimizing the risk of damage to nearby structures.
• Less invasive: This technique is less invasive than traditional open surgery. It typically requires a one- to two-inch midline incision, which can result in some tissue disruption but still far less than conventional spine surgery. The incision and approach go through the stabilizing longissimus muscles in your back, which are part of the erector spinae muscle. 
• Recovery and hospital stay: Patients undergoing microdiscectomy may require several weeks to months of recovery and experience some postoperative pain. If you have a physically demanding job or lead an active lifestyle, you should anticipate a minimum six- to eight-week recovery period. However, the surgery typically involves a hospital stay of less than 24 hours.

Endoscopic Discectomy — The Ultra-Minimally Invasive Challenger

Endoscopic spine surgery is a game-changer that is redefining how spine surgeons operate. This cutting-edge, ultra-minimally invasive technique offers patients a path to recovery with smaller incisions, faster healing and less postoperative pain and discomfort.

• Minimally invasive approach: Endoscopic spine surgery and minimally invasive microdiscectomy surgery are pioneering approaches designed to alleviate spinal issues with reduced surgical trauma. However, endoscopic spine surgery is even less invasive. It employs a slender tube with an attached camera to achieve unparalleled precision through a quarter-inch incision, making it the least intrusive spine surgery. While both approaches prioritize patient comfort and faster healing, the endoscopic method can translate into shorter hospital stays and a swifter return to daily life. 
• Patient selection: The choice between the two depends on your circumstances and the specific spinal condition, but both surgeries exemplify the medical field’s commitment to achieving optimal outcomes with minimal disruption to patients’ lives. Not all spine conditions are conducive to an endoscopic procedure. Your surgeon will determine your candidacy for microdiscectomy or endoscopic spine surgery based on many factors, including your age, health and the herniated disc’s location.

The Advantages of Endoscopic Spine Surgery

Endoscopic spine surgery offers numerous advantages over microdiscectomy surgery. Studies and clinical evidence have shown this innovative approach has many benefits, making it an attractive option for patients and surgeons. 

One significant advantage of endoscopic spine surgery lies in its ability to expedite recovery. Many patients undergoing endoscopic procedures report reduced postoperative pain and discomfort, resulting in a swifter return to work and daily life, typically within two to four weeks. In contrast, conventional microdiscectomy surgeries may necessitate prolonged rehabilitation and downtime, affecting your overall quality of life and extending the minimum recovery period to six to eight weeks.

Potential Complications of Each Procedure

When considering which procedure works better for you, it is vital to also understand the risks you may face. Though both options are safe and most operations are successful, exploring the potential complications that could occur during each is still worthwhile to explore. However slim these chances might be, you should still know what they are before making your final choice.

Microdiscectomy 

Every surgical procedure brings a risk of complications, and the spine is a sensitive area and a vital body part. However, minimally invasive techniques are typically safer, with shorter recovery periods.

Several lifestyle-related factors might adversely affect surgical outcomes, procedure success and patient recovery. These include obesity, habits like smoking and jobs requiring heavy manual labor. Age is another variable that can affect the possibility of a complication occurring. 

From minor problems that a surgeon can resolve in the moment to more serious issues that need further intervention, these are the procedure-related complications associated with microdiscectomies.

• Dural tear: If the surgeon accidentally nicks the spinal cord’s outer membrane, it causes cerebrospinal fluid to leak. Reduced CSF pressure to the brain results in headaches, nausea and vomiting. The reported dural tear incidence in spinal surgeries is 3% to 16%. Excessive traction on the nerve due to a herniated disc increases the risk of this happening.
• Nerve injury: There is a 1% to 2 % chance of incurring any nerve injury during microdiscectomy surgeries. Depending on the severity of the damage, it can lead to short-term symptoms or long-term issues.
• Blood vessel injury: Vascular injuries are rare, occurring in less than 1% of all spinal surgeries. 
• Failed back surgery syndrome: Recurrence of disc herniation can cause FBSS, which is when lower back pain remains or reappears after back surgery. Some patients might require revision surgery to alleviate this condition.

Endoscopic Discectomy

Compared to traditional surgical procedures, endoscopic discectomies cause fewer severe injuries or adverse outcomes. These complications could happen during and after an endoscopic discectomy.

• Nerve damage: Developing nerve damage during this procedure is rare. Based on the injury’s severity, it can cause varying pain levels and could lead to other complications.
• Bleeding: Bleeding is likely to happen after most surgical procedures. However, when bleeding is persistent and heavy, it signifies something is wrong. Postsurgical bleeding for this type of operation should be less significant than most others.
• Infection: Your orthopedist will provide you with antibiotics to take before and after the procedure to help your body fight bacterial infections while healing.
• Returning symptoms: There is a roughly 5% chance of the disc herniating again after the procedure. Consult your orthopedist if this occurs.

Outpatient Setting — Awake Spine Surgery

Awake spine surgery offers distinct advantages, such as reduced reliance on general anesthesia, faster recovery times and real-time patient feedback during the procedure. Outpatient awake endoscopic spine surgery represents a significant advancement in minimally invasive spine procedures, offering a range of compelling benefits. By avoiding general anesthesia, patients experience fewer risks and side effects, making it a safer option for people with specific health concerns. The outpatient setting allows for a quicker return home, reducing hospital costs and minimizing the risk of hospital-acquired infections. 

• Reduced damage to surrounding tissues and muscles: One of the most notable advantages of endoscopic spine surgery is the minimal damage it inflicts on surrounding tissues and muscles. With endoscopic procedures, the surgeon can access the affected area with smaller incisions and less disruption to adjacent structures, resulting in less postoperative pain and a speedier recovery.
• Superior visualization and precision: Endoscopic surgery offers surgeons an expanded field of view and a high-definition perspective of the targeted area that enables them to make precise, targeted interventions, reducing the risk of errors and complications. The ability to visualize the spine in detail allows for safer and more effective surgeries, increasing overall patient satisfaction rates.
• Patient selection and proficiency: Not all cases are suitable for endoscopic discectomy, and mastering this technique demands specialized training and experience with a substantial number of cases. Fortunately, patients who turn to Desert Institute for Spine Care can be confident in their choice. Our surgeons have pioneered the endoscopic discectomy technique and have also taught it for over 25 years. With over 10,000 successful procedures performed, our surgeons are global leaders in the field of spine surgery, ensuring the highest level of expertise and care for our patients.

Becoming an Informed Patient — Herniated Disc Treatment Factors to Consider 

Endoscopic spine surgery represents a significant step forward. The studied benefits are clear and compelling, including faster recovery, the potential for outpatient treatment, less damage to surrounding tissues and enhanced precision. As technology continues advancing, endoscopic spine surgery will become an even more attractive option for patients seeking relief from spinal conditions. However, you should only choose surgery after consulting with a qualified medical professional who will evaluate your specific condition and needs.

Choosing between microdiscectomy and endoscopic discectomy can be a pivotal decision for spine patients seeking relief from the discomfort of herniated discs. The decision hinges on several crucial factors. Microdiscectomy has a well-established track record and is the most commonly used procedure by spine surgeons. On the other hand, endoscopic discectomy stands out as an ultra-minimally invasive alternative, ideal if you want a swifter recovery. 

Your surgeon’s expertise is paramount in this choice. Engaging in open communication with your health provider, sharing your preferences and considering each option’s pros and cons will ultimately guide you toward the procedure best suited to your needs. 

Whether it’s the reliability of microdiscectomy or the appeal of minimally invasive endoscopic discectomy, both paths lead to the common goal of alleviating your pain and restoring your quality of life. Contact us at DISC to make an appointment or request a second opinion.