Minimally Invasive Surgery for Disc Herniation: Key Insights and FAQs

Q: Minimally Invasive Surgery for Disc Herniation: Key Insights and FAQs

Hello： A. <br>I see that you are seriously researching this topic, but you might be overwhelmed by the vast amount of information available online, leading to confusion. <br>Many young internet users face similar challenges, getting misled by technical jargon and certain medical

Hello Director Lai: I would like to ask you for educational information regarding my herniated disc?

Hello Director Lai, thank you for taking the time to respond.
Considering economic factors and my limited understanding of medical terminology, I am reaching out to you online for advice.
Many of my questions may seem superficial, and I appreciate your understanding.
Please feel free to correct me.
1.
Introduction
Due to pain in my right lower back and calf, and with no improvement from rehabilitation and only relying on painkillers, I was referred to a hospital for examination, which included X-rays, MRI, and HLA-B27 (Negative).
I was advised to consider decompression surgery.
The first type of surgery has a 3 cm incision and requires a 5-day hospital stay, while the second type has a 1 cm incision and requires a 2-day hospital stay.
The latter has a quicker recovery time but is more expensive, with limited differences in effectiveness.
The doctor suggested I research and consider my options.
1.
Report findings:
- L spine: L4-L5 right paramedian disc protrusion causing compression of the right lateral recess
- L5-S1 mild posterior bulging disc
2.
Diagnosis:
- Lumbar degenerative spondylitis (without myelopathy or radiculopathy)
- Lumbar spinal stenosis
- Lumbar spondylolisthesis
2.
Questions:
1.
Is it necessary for minimally invasive surgery to involve an endoscope, or can microscopic techniques also be considered minimally invasive? I am concerned about potential miscommunication.
2.
Can I understand that there are four types of surgery?
(a) Traditional
(b) Microscopic
(c)
(d) Minimally invasive
(a) Open lumbar discectomy is a traditional surgery with ideal outcomes but has the disadvantages of larger incisions, more blood loss, and longer hospital stays.
Due to technological advancements, this method is used less frequently.
(b) Microscope-assisted lumbar discectomy is performed under microscopic assistance, with treatment outcomes comparable to standard open surgery.
The advantages include smaller incisions, less blood loss, and shorter hospital stays.
(c) Minimally invasive lumbar discectomy uses a minimally invasive surgical cannula, performed under microscopic or endoscopic assistance, achieving similar outcomes to previous surgeries, with incisions reduced to less than 2 cm, making it the mainstream surgery.
(d) Endoscopic minimally invasive lumbar discectomy (commonly referred to as percutaneous endoscopic discectomy) is performed entirely using spinal endoscopy, resulting in less damage to bone and muscle tissue, with incisions less than 1 cm, and is expected to be the future mainstream approach.
3.
Did my attending physician indicate that the first type of surgery is (b) and the second type is (c or d)? I inferred this from the size of the incisions.
My doctor speaks softly, and I sometimes struggle to understand the medical terminology.
I also feel a bit timid about asking too many questions.
4.
Regarding costs and rehabilitation periods, could you please clarify?
(a) National Health Insurance coverage: 3 months
(b) 30,000: 1 month
(c) Over 100,000: almost none
(d) Over 100,000: almost none
5.
Regarding adhesion issues, I would like to know how effective imported medications are in avoiding the need for a second surgery, as I am trying to save money.
6.
Regardless of the type of surgery chosen, is the risk of paralysis relatively low? I have seen that the risk for traditional surgery is one in a thousand, and I would rather die than be paralyzed.
I apologize, Director Lai, as this understanding comes from my research online.
Please correct my misconceptions when you have the time.
Thank you!

Miss Chen, 20~29 year old female. Ask Date: 2022/11/15

Dr. Lai Zhaokang reply Neurosurgery

Hello: A.
I see that you are seriously researching this topic, but you might be overwhelmed by the vast amount of information available online, leading to confusion.
Many young internet users face similar challenges, getting misled by technical jargon and certain medical advertisements.
B.
Your understanding is generally correct; however, there is no standardized definition for "minimally invasive spine surgery" in our industry.
Generally speaking, it differs from traditional open surgery, where the surgeon operates with direct visual access through a large incision.
Instead, it involves the use of microscopes/endoscopes/microscope combined with endoscope/microscope with tubular retractors/...
and even navigation systems or robotic arms, all of which fall under the category of minimally invasive surgery.
C.
Medical instruments are advancing, and new equipment is constantly being developed, all aimed at ensuring safety, effectiveness, smaller incisions, and shorter recovery times.
Ultimately, no matter the method used, it cannot replace the surgeon's eyes, hands, and experience! The operation is performed by the physician.
D.
If you look back at recent information, Vice President Lai Ching-te, who is also a physician, chose a specific surgical method for his own medical care.
E.
In fact, regardless of the surgical method, having a surgeon with professional experience like mine performing the procedure is generally very safe.
F.
As for anti-adhesion techniques and others, they are meaningful and worth considering, as long as you can afford the costs.
G.
In conclusion, you seem to be experiencing decision-making difficulties.
I recommend that you choose based on what you can financially manage.
Best wishes from Dr.
Lai Chao-kang, Director of Spine Surgery at Changhua Hospital.

Reply Date: 2022/11/15

More Info

Minimally invasive surgery (MIS) for disc herniation has gained significant traction in recent years due to its potential benefits over traditional open surgery. Understanding the nuances of these surgical options is crucial for patients considering treatment for conditions like lumbar disc herniation. Below, I will address your questions and provide insights into the various surgical approaches, their implications, and recovery expectations.

1. Definition of Minimally Invasive Surgery
Minimally invasive surgery does not strictly require the use of an endoscope; it can also involve the use of a microscope. The key characteristic of MIS is that it aims to minimize tissue damage and reduce recovery time compared to traditional open surgery. Techniques may include the use of small incisions, specialized instruments, and sometimes imaging guidance to enhance precision.

2. Types of Surgical Approaches
You have accurately categorized the types of surgeries. Here’s a brief overview:
- (a) Traditional Open Surgery: This involves a larger incision, typically resulting in more tissue disruption, longer recovery times, and higher blood loss.

- (b) Microscope-Assisted Surgery: This technique uses a microscope to enhance visibility while making a smaller incision than traditional methods. It offers similar outcomes with reduced recovery time.

- (c) Minimally Invasive Surgery: This involves the use of tubular retractors and may utilize either a microscope or an endoscope. The incision is usually less than 2 cm, leading to quicker recovery and less postoperative pain.

- (d) Endoscopic Surgery: This is a more advanced form of MIS where the entire procedure is performed through a very small incision using an endoscope, often resulting in minimal tissue damage and scarring.

3. Surgical Options Based on Your Case
Based on your description, it seems your first option (3 cm incision) likely corresponds to microscope-assisted surgery (b), while the second option (1 cm incision) aligns with minimally invasive techniques (c or d). Your surgeon’s choice may depend on the specific characteristics of your herniation and your overall health.

4. Cost and Recovery Time
Costs can vary significantly based on the type of surgery, hospital policies, and insurance coverage. Generally, minimally invasive procedures may have higher upfront costs due to advanced technology but can lead to shorter hospital stays and quicker recovery times. Recovery periods can range from a few weeks to several months, depending on the procedure and individual healing rates.

5. Adhesion Prevention
Adhesions can be a concern after any abdominal or spinal surgery. While there are products available that may help reduce the risk of adhesions, their effectiveness can vary. Discussing these options with your surgeon can provide clarity on whether they are appropriate for your situation.

6. Risk of Paralysis
The risk of paralysis from spinal surgery is generally low, especially when performed by experienced surgeons. The risk can vary based on the complexity of the surgery and the specific condition being treated. While traditional open surgeries may have a slightly higher risk, advancements in surgical techniques have significantly reduced these risks across all types of procedures.

Conclusion
In summary, minimally invasive surgery offers a promising alternative to traditional surgical methods for treating disc herniation. It is essential to have a thorough discussion with your healthcare provider about the best approach for your specific condition, considering factors such as the extent of the herniation, your overall health, and personal preferences. Understanding the differences between surgical options can empower you to make informed decisions about your treatment. Always feel free to ask your surgeon any questions you may have; clear communication is vital for a successful outcome.

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