This minimally-invasive procedure is performed through a small tubular device. It is designed to relieve pain caused by herniated discs pressing on nerve roots. The surgery is performed under local or epidural anesthesia, allowing the patient to leave the hospital the same day.
After the disc protrusion is confirmed, a guide wire is inserted to the affected disc. The surgeon uses a special type of x-ray machine called a fluoroscope to ensure that the route to the herniated disc is made in the correct location. A two-hole obturator tube is passed over the guide wire to push apart the tissue down to the disc and to move the nerve root out of the way. Painful tissue in the path of the obturator may be anesthetized. The working sleeve, through which the surgery will be performed, is slid over the dilating tube. It is positioned on the disc surface. The guide wire and dialator are then removed. An endoscope (which contains a surgical light and small camera) is placed through the tube, allowing the surgeon to view the annulus, disc, and epidural space on a video monitor. The surgeon will use the endoscope to guide the surgical tools and inspect the results. The surgeon uses instruments to remove degenerative and extruded portions of the disc nucleus. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable. The disc wall defect is treated with a laser and radiofrequency probe. The foramen and nerves are inspected to confirm successful decompression. The instruments and sleeve are removed. The insertion area in the skin is covered with a small bandage. Because no muscles or bone are cut during the procedure, recovery is fast and scarring is minimized. The patient may need a day of bed rest after the procedure and physical therapy. Most patients may return to normal activity within one to six weeks.