Our Summary

This research paper reviews the different types of minimally invasive surgeries that are used to treat recurring lower back disc hernias. These are a more complex issue than initial hernias, often leading to higher rates of illness. Because the operating area is limited, many surgeons have been hesitant to use minimally invasive methods for these repeat surgeries.

However, minimally invasive methods are becoming more popular for treating initial hernias, and more patients are interested in these methods for their repeat operations. Three types of minimally invasive methods - microendoscopic discectomy (MED), endoscopic transforaminal discectomy (ETD), and endoscopic interlaminar discectomy (EID) - have been used to treat recurring hernias, with success rates between 60% and 95%.

Full endoscopic techniques, particularly ETD, have shown good results regarding the rates of dural tear (a common complication), but they require a lot of practice to master. If the disc fragments have moved or if there is narrowing of the lateral recess, MED is a more effective method. All three methods have a low rate of delayed instability.

In conclusion, MED, ETD, and EID are safe and effective options for treating recurring lower back disc hernias. They have high success rates and low complication rates, and provide the benefits of minimally invasive access.

FAQs

  1. What are the three types of minimally invasive methods used to treat recurring lower back disc hernias?
  2. What are the success rates of minimally invasive methods for treating recurring hernias?
  3. What are the benefits of using minimally invasive methods for treating recurring lower back disc hernias?

Doctor’s Tip

One helpful tip a doctor might tell a patient about discectomy is to carefully follow post-operative instructions to promote proper healing and recovery. This may include restrictions on physical activity, proper wound care, and attending follow-up appointments with the surgeon to monitor progress. It is important to communicate any concerns or changes in symptoms to the doctor to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for discectomy procedures are those with recurring lower back disc hernias who have not responded to conservative treatments such as physical therapy, medication, or injections. These patients may be experiencing symptoms such as persistent pain, weakness, numbness, or tingling in the legs that are affecting their daily activities and quality of life.

It is important for patients to undergo a thorough evaluation by a spine specialist to determine if they are suitable candidates for discectomy surgery. Factors such as the location and severity of the herniated disc, the presence of nerve compression, and the overall health and medical history of the patient will be taken into consideration when determining the best course of treatment.

Overall, patients who are in good overall health, have realistic expectations for the outcome of the surgery, and are motivated to participate in post-operative rehabilitation are typically recommended for discectomy procedures. It is important for patients to discuss their options with their healthcare provider to determine the most appropriate treatment plan for their individual needs.

Timeline

Before discectomy:

  1. Patient experiences recurring lower back pain, leg pain, numbness, or weakness due to a recurring disc herniation.
  2. Patient undergoes diagnostic tests such as MRI or CT scan to confirm the diagnosis.
  3. Patient may try conservative treatments such as physical therapy, pain medications, or epidural injections to manage symptoms.

After discectomy:

  1. Patient undergoes minimally invasive discectomy surgery to remove the herniated disc fragments.
  2. Surgery is performed using a small incision and specialized tools to minimize tissue damage.
  3. Patient experiences relief from symptoms such as pain, numbness, or weakness in the affected area.
  4. Recovery period includes physical therapy to strengthen the back muscles and improve flexibility.
  5. Patient gradually returns to normal activities and experiences improved quality of life without the symptoms caused by the recurring disc herniation.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a discectomy procedure?
  2. How long is the recovery period after a discectomy and what can I expect during the recovery process?
  3. Are there any alternative treatment options to consider before proceeding with a discectomy?
  4. How experienced are you in performing minimally invasive discectomy procedures?
  5. What is the success rate of minimally invasive discectomy for treating recurring lower back disc hernias?
  6. Will I need physical therapy or rehabilitation after the procedure?
  7. How soon can I return to work or resume normal activities after a discectomy?
  8. Are there any specific lifestyle changes or precautions I should take after the surgery to prevent future disc hernias?
  9. Will I need any additional imaging or follow-up appointments to monitor my recovery progress?
  10. What are the long-term outcomes and prognosis for patients who undergo a discectomy procedure?

Reference

Authors: Kogias E, Franco Jimenez P, Klingler JH, Hubbe U. Journal: J Clin Neurosci. 2015 Sep;22(9):1382-6. doi: 10.1016/j.jocn.2015.02.028. Epub 2015 Jun 27. PMID: 26122379