Suffering from a herniated disc? With any luck you’ll be among the 80 percent of herniated disc cases that resolve themselves. However, if you don’t see any improvement in about six weeks, and these commonly recommended conservative treatments aren’t having an impact, it might be time to talk with your doctor about surgical options.
The most common treatment for a first-time, isolated herniated disc is a microdiscectomy, but you may have also heard of a microendoscopic discectomy. In this article, we’ll explain what a microendoscopic discectomy is and how it differs from the more traditional microdiscectomy.
What is a lumbar microendoscopic discectomy?
In cases of a herniated disc, the purpose of any type of surgery is to relieve pain by removing whatever portion of the affected disc is compressing or irritating a specific nerve root.
Both a microdiscectomy and a microendoscopic discectomy accomplish this goal with equally satisfactory outcomes.1 However, there are slight differences in how the surgeries themselves are performed:
- Incision size: A microdiscectomy uses an incision approximately one inch long; lumbar microendoscopic discectomy surgery incisions are smaller, about a half-inch.
- Access to the spine: In a microdiscectomy, the surgeon works directly through the incision point using some form of vision enhancer (such as loops or a microscope), with tube-based retractors and fine instruments to carefully move the nerve root out of the way and remove the necessary disc material. Lumbar microendoscopic discectomy surgery is performed exclusively through tubes—an access cannula, a camera tube, and a small light allowing your surgeon to see the disc on a screen. Using very small surgical instruments, the doctor removes the herniated portion of the disc, aided by the camera.
Both surgeries are done on an outpatient basis, so patients go home the same day.
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Lumbar microendoscopic discectomies are more popular in Asia than they are in the U.S.; here they constitute about 5% of all disc surgeries.
One of the reasons this type of surgery is less common is because there are limitations as to the type of disc herniation it can address. There are three types of herniations, each of which indicates the region of the disc that may need to be removed: central herniation, paracentral (just beside the center of the disc, either on the right or left side), and far lateral (posterior most lateral location). Microendoscopic discectomies are best suited for far lateral herniations simply because this part of the disc is more easily accessible by this type of procedure; but far lateral herniations occur in a much smaller percentage of cases than the other two types.2
Microendoscopic Discectomy Recovery Time
Less tissue destruction means faster recovery, which is why microendoscopic discectomy recovery time is slightly less than a traditional microdiscectomy.3
Most microdiscectomy patients can return to light-duty, office-type work at about 10 days after surgery, or to heavy manual work four to six weeks later. In contrast, lumbar microendoscopic discectomy patients might return to office work two or three days faster.
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1Righesso, O., Falavigna, A., & Avanzi, O. (2007). Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery, 61(3), 545-549.
2Al-Khawaja, D. O., Mahasneh, T., & Li, J. C. (2016). Surgical treatment of far lateral lumbar disc herniation: a safe and simple approach. Journal of Spine Surgery, 2(1), 21.
3Casal-Moro, R., Castro-Menéndez, M., Hernández-Blanco, M., Bravo-Ricoy, J. A., & Jorge-Barreiro, F. J. (2011). Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clinical study with a 5-year follow-up. Neurosurgery, 68(6), 1568-1575.