Virtually all Americans—up to 80 percent, according to the American Academy of Orthopaedic Surgeons—will suffer from some degree of back pain during their lives. Among the most common causes of lower back pain is a herniated lumbar disc, in which the inner lining of the spinal disc bulges and causes pressure on the outer ring of the disc or protrudes and presses against the spinal nerves.
This can cause not only back pain, but also pain, weakness, and/or numbness in the leg or foot. In severe cases, it may cause loss of bladder or bowel control as part of a condition known as cauda equine syndrome.
Historically, lower back pain is first treated conservatively through non-surgical methods. However, when a herniated disc does not respond to non-surgical treatment or when the severity of the condition requires immediate attention, as in cauda equine syndrome, surgical treatment may be necessary.
Sometimes a Tampa Bay spinal surgeon may recommend microscopic discectomy, an open surgery in which the surgeon removes part of the disc. However, in recent years, surgeons have developed a minimally-invasive spine surgery to treat lower back pain and sciatica associated with herniated lumbar disc. This surgery is known as endoscopic discectomy.
How Endoscopic Discectomy Differs from Microscopic Discectomy
Both microscopic (open) discectomy and endoscopic discectomy accomplish virtually the same thing—to remove herniations from the affected discs in order to restore function and alleviate pain and other conditions associated with bulging discs that do not respond to conservative treatment.
One difference in the two procedures, according to the Centers for Medicare and Medicaid Services (CMS) is how the surgeon visualizes the affected area during the surgery:
- In microscopic discectomy, the surgeon has direct visualization of the surgical area, enhanced by the use of microscopes or loupes, special eyeglasses fitted with microscopic lenses.
- In endoscopic discectomy, the surgeon views the surgical area through an endoscope, often outfitted with a high-definition camera and video system.
For patients, the most important difference is the degree of invasiveness of each procedure. In open surgery, the surgeon must generally make an incision of at least 20 mm in order to access the surgical site, according to CMS; for endoscopic discectomy, that incision need only be about 7 mm. This smaller incision area can lead to less trauma to surrounding tissues, less scarring, and an easier recovery for many patients.
Other advantages of endoscopic techniques over open surgery may include the following:
- Shorter operating time
- Less blood loss during surgery
- Typically does not require general anesthesia
- Fewer complications
- Less postoperative pain
- Faster recovery
If your lower back pain is not improved through non-surgical methods such as rest, physical therapy, and anti-inflammatory medications, your doctor may recommend an MRI to determine whether a herniated disc is to blame for your discomfort. If the MRI indicates a bulging, slipped, or herniated disc, spinal surgery may be an appropriate treatment option for you.
Which Spine Surgery is Right for Me?
If spine surgery is required to bring relief from lower back pain and/or sciatica, talk to your surgeon about the risks and benefits of each type of surgery. The goal of treatment is to provide the best possible results with the least amount of trauma to the patient. Your spine surgeon can help you determine which procedure is right for you.