Endoscopic Discectomy (PELD)
Transforaminal Endoscopic Discectomy or Percutaneous Endoscopic Lumbar Discectomy (PELD)
is an innovative, minimal-invasive technique to treat the patients suffering from Slip Disc / Sciatica which is designed to efficiently access the damaged disc without injury to surrounding disc anatomy. The treatment is done under local anesthesia with or without sedation. It is especially very safe for the old patients as well as the patients who are suffering from other diseases like BP, Diabetes, Heart diseases, etc. as it is done under Local Anesthesia avoiding General Anesthesia.
DISC ANATOMY AND CONTAINED DISC HERNIATIONS
The spine is composed of a series of bones called the vertebrae. Each of these bones is connected by a disc, made of a tough outer layer, called the annulus, and a gel-like center called the nucleus. If the annulus of the disc is damaged by injury or weakened by age, a portion of the outer layer can give way to pressure causing the gel-like nucleus to either bulge or leak out. This may also be referred to as a herniated disc. A herniated disc can press on the nerves and cause pain, numbness, tingling or weakness in the back and/or leg.
TREATING CONTAINED DISC HERNIATIONS
In the past, patients with disc herniation / Slip Disc / Sciatica have been treated with conservative care including rest, medications, injections and/or physical therapy. Unfortunately, this does not always provide relief. In the past, people who did not respond to conservative care were forced to live with the symptoms or consider major spine surgery. If they underwent surgery, it could take weeks or months to recover, causing a major disruption in their daily lives.
Percutaneous Endoscopic Lumbar Discectomy (PELD) provides an option for those people who have failed conservative care, and are not yet ready for major surgery. It is a minimal access procedure performed on an out-patient basis whereby the patient will go home the same day.
WHO IS A CANDIDATE FOR THE PROCEDURE?
Patients with symptomatic, lumbar disc herniation that have not responded to conservative treatment may experience relief from the Percutaneous Endoscopic Lumbar Discectomy (PELD). Typical signs of a contained lumbar disc herniation are lower back pain or pain radiating down the leg accompanied by some lower back pain.
POTENTIAL BENEFITS OF THE PROCEDURE:
- Out-patient procedure
- Smaller skin incision than traditional surgery
- Short procedure time
- Under Local anesthesia
- Targeted access to damaged (diseased) area
- Quick relief of symptoms
- Earlier return to normal activities
- Minimal tissue damage
- Preserves all additional surgical options, should they be needed
PRIOR TO THE PROCEDURE
Medical evaluation includes a physical examination, diagnostic tests such as X-ray, MRI (Magnetic Resonance Imaging) to diagnose and locate the symptomatic disc herniation and to determine which disc to be treated.
The Percutaneous Endoscopic Lumbar Discectomy (PELD) requires the patient to lie on their stomach throughout the procedure. Minimal anesthesia requirements are typically necessary. A needle is inserted into the skin near the affected disc level, followed by an incision through which a working tube (sheath) and scope is placed. Graspers are used to manually remove and decompress the offending herniation. At the conclusion of the procedure, the scope with sheath is removed and a single stitch is applied to close the incision.
See the procedure on this You Tube link: https://www.youtube.com/watch?v=2MmGXhIED78
AFTER THE PROCEDURE
Patients are required to remain at the hospital after the procedure for observation which is typically 2 - 4 hours. Upon release, patients are then informed to take rest for 1 -2 weeks with limited sitting or walking. In most cases, symptoms caused by the disc herniation are gone or diminished within two weeks. A patient may experience some discomfort or bruising where the incision was created where Ice-pack massage is required from the day-one. Stitch is remover after 7 – 10 days. After about one week, patients participate in physical therapy which is important for a full recovery. They are typically allowed to engage in some physical activity and return to work.
ARE THERE ANY COMPLICATIONS WITH THE PROCEDURE?
- • Complications are very less. Like other operations infection is most important and to avoid infection all types of aseptic measures are taken care from pre-operative period to post-operative period.
- • As the operation is done under local Anesthesia, hazards of General Anesthesia can be avoided.
- • As the operation is done under local Anesthesia, if anytime during operation nerve is touched, patient is very much aware to notice that. That’s why no risk for major injury. If patient is under General Anesthesia, he or she will not be aware if the injury is severe. That’s why complication may be severe in General Anesthesia in Major operation.
- • In major spine surgery bones are also cut (Laminectomy) which affects the spine stability in future which is not possible in Percutaneous Endoscopic Lumbar Discectomy (PELD) as bone is not cut in this technique. Problem is in the Disc and only Disc is treated.
- • Bleeding is another complication in open major spine surgery. But in Percutaneous Endoscopic Lumbar Discectomy (PELD) bleeding is very less as the surgical area is very less.
- • In Percutaneous Endoscopic Lumbar Discectomy (PELD) muscles are not cut, rather they are separated by the dilator. That’s why no suture is needed inside. Only one stitch at skin is enough to close the wound and wound healing is very fast. Where in open Spine surgery wound big and wound healing is another important topic to be considered, especially for Diabetic patients.