Sciatica or lumbosciatica is a very frequent ailment, more and more, in a large part of the population. It is therefore a problem that is prevalent in our society. In fact, a study published in Spine considers that up to 90% of the population has suffered at some time in their lives a crisis of low back pain, irradiated or not.
Most of the time, these crises are solved with conservative treatment, by means of analgesia, relative rest and physiotherapy.
But pain radiating to one or both legs has a series of special characteristics. The first is that the pain is much worse tolerated, and the second is that sometimes it can be accompanied by symptoms suggestive of neurological deficit, such as loss of strength or sensitivity in the area that depends on the affected nerve.
This pain radiating to the legs usually occurs because a herniated lumbar disc, which is a part of a disc that slips out of place, compresses one of the nerves leading to the legs.
When is lumbar discectomy necessary?
In cases in which the sciatic pain does not subside with conservative measures after a reasonable time, or is accompanied by neurological damage, is when the orthopedic specialist begins to consider surgical treatment, since it is possible that a prolonged compression of the nerve root ends up producing permanent damage to it that does not subside after surgical decompression.
The classic surgical treatment of disc herniation has consisted of open removal of the extruded disc fragments and the rest of the disc. This technique is the Gold Standard against which all other disc removal techniques are compared. It is also true that in the last thirty years there have been attempts to remove or dissolve the disc in a less invasive way, as in the case of chemonucleolysis, microsurgery, laser surgery, etc. All of these techniques are either no longer used or have specific indications with their advantages and disadvantages.
Discectomy by endoscopy, the latest development
Thus, the technique par excellence is still the removal of the disc, and it is in this case when a minimally invasive way of doing it comes into play, which is the endoscopic discectomy. This technique consists in the removal of the disc by means of a video-assisted and percutaneous approach.
Video-assisted surgical techniques already have a long tradition in surgery, as is the case with arthroscopic surgery, laparoscopy, etc. Therefore, in this case, it is a matter of removing the herniated disc fragment that is compressing the nerve without having to make more than a small incision of 1 cm.
It is a surgery that has the same results as conventional surgery, but with much less risk of pain and postoperative infections than the latter. Recovery is infinitely faster, and if there are no complications, hospital discharge can be given once the anesthesia is over.
Its other great advantage is that by using imaging systems that magnify, the disc can be removed with the least possible damage to the rest of the lumbar structures, which makes it a percutaneous technique that allows reincorporation to a daily life with slight restrictions almost immediately.
Endoscopic discectomy, therefore, consists of the removal of the herniated disc “on sight” by means of a camera and special cannulas but with the minimum possible damage, just as today a meniscus or a gall bladder is removed by similar techniques, but in a safer way and with a much faster and more comfortable recovery.
In conclusion, it is important to take into account the safety and postoperative comfort thanks to the minimal injury to adjacent soft tissues and the optical magnification techniques. It will undoubtedly be the disc removal technique of the future.