Epiduroscopy
assisted endoscopic percutaneous removal of the intervertebral disc fragment
Procedure description
This endoscopic procedure is most commonly performed in patients with chronic back pain caused by some types of herniated intervertebral discs. The disc herniation may cause loss of sensitivity to paralysis. Such patients do not experience long-term improvement after periradicular therapy (PRT) and have positive MRI findings. A special, X-ray guided needle is introduced to the spine (most often laterally through the foramen intervertebrale) to form a working channel. Then an endoscope and a set of surgical tools are introduced. An inserted endoscope shows how far the herniated disc is pushing against the nerve root. Subsequently, under continuous visualization, a herniated part of the disc is removed with special forceps. Finally, the disc is treated with a special thermal radiofrequency to seal the end ring of the damaged disc in the end plate segment. The aim is to reduce the risk of recurrent herniation and to eliminate pathologic nerve structures both around the disc and inside of it that are causing pain.
After removal of the intervertebral disc fragment, we access through the natural opening in the sacrum (hiatus sacralis) the anterior epidural space with a flexible endoscope (epiduroscope). The aim of this procedure is the optical visualization of the anterior epidural space in the sacral and lumbar channel area up to the height of the performed endoscopic discectomy. In the case of the discovery of pathological changes in the epidural space, immediate additional therapeutic intervention is possible (administration of anti- inflammatory drugs, the breakdown of adhesions, residual disc fragments).
The duration of the procedure ranges from 40 to 90 minutes. The surgery is performed under general or local anaesthesia. In contrast to classical surgery, there is minimal damage to muscular and bone structures. The advantage of this technique is also faster recovery and return to active life.
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