Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease, to determine the affected level, and to decide on the type of surgery. Endoscopic discectomy is a minimally invasive decompressive procedure used to treat spine disease symptoms in the lumbar region.

An endoscopic discectomy is performed with the patient lying on their stomach with the lower back pointed upward. A specialized intraoperative x-ray machine, a fluoroscope, is available and used throughout the spinal surgery to ensure that the correct vertebra/vertebrae is being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterilely. A small, less than one inch, incision is made on the midline of the lower back. A guidewire, a long thin metal wire, is place with the guidance of the fluoroscope. Once the guidewire is at the appropriate position and touching the lamina of the target vertebral body, a series of cylindrical dilators are placed over the wire to gently move the tissue from the surgical field. When the appropriate dilation is met, a specialized retractor is placed over the dilators and the dilators are removed. The retractor keeps the incision open for the duration of the procedure, allowing the surgeon to see and operate without surgically opening the back. Specialized Instruments are placed through the retractor to remove the disc herniation compressing the nerve. Once the nerve on the target side of the body is decompressed, the retractor is readjusted to evaluate the compression of the spinal nerve on the opposite side. Any compression on this nerve from disc fragment is also removed.

Once the nerve roots are decompressed, the procedure is complete and closing may begin. The retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing. The final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After the procedure is completed, the patient recovers at the surgery center and is typically able to go home within a couple of hours of the procedure. Prior to discharge home, a patient needs to have pain under control, urinating normally, walking, and tolerating food and beverage. A friend or family member should be available to drive the patient home and should also be available to monitor the patient for at least 24 hours after the procedure.