single-portal technique
bi-portal technique
Endoscopic discectomy and decompression is a relatively recent minimally invasive surgical technique in the field of spinal surgery. This method was developed with the aim of treating certain spinal conditions, in particular disc herniations and spinal canal stenosis or foraminal stenosis, while reducing trauma to the muscle tissue and surrounding anatomical structures.
The procedure is performed using an endoscope, an instrument equipped with an optical system and light source, which allows the surgeon to visualize the surgical field through small skin incisions.
Thanks to endoscopic visualization, it is possible to reach the site of nerve compression and carry out targeted decompression maneuvers and, when necessary, removal of the herniated disc material.
Indications
This technique may be indicated in patients with lumbar disc herniation, foraminal stenosis, lateral stenosis, lateral recess stenosis or other conditions in which a nerve root is compressed by disc tissue, thickened ligaments or degenerative bone structures.
The goal of the procedure is to free the compressed nerve root, reducing pain radiating into the limb, tingling, altered sensation and, in selected cases, promoting the recovery of any neurological deficits. The procedure may be considered when conservative treatments, such as medication, physical therapy or injections, have not provided sufficient benefit, or in the presence of persistent, disabling symptoms.
Correct surgical indication is essential, as not all herniations or stenoses are suitable for endoscopic treatment. The choice depends on the site of the condition, the degree of compression, the patient’s anatomy and the surgeon’s experience.
Single-portal technique
The single-portal technique involves a single skin access. Through one incision, an operative tube is introduced that allows both visualization of the surgical field and the passage of the instruments needed for decompression and discectomy.
In this approach, the endoscope and surgical instruments work within the same channel.
The surgeon visualizes the anatomical structures on a monitor and, through the operative channel, can remove the herniated disc fragment, free the nerve root, or remove small portions of bone or ligament tissue responsible for the compression.
The main advantage of the single-portal technique is its extreme minimal invasiveness, since the procedure is performed through a very small access. However, the working space is more limited and requires a specific learning curve.
Bi-portal technique
The bi-portal technique, now increasingly widespread, uses two small separate accesses.
One of the two is used to introduce the endoscope, which allows continuous visualization of the surgical field; the second access is instead dedicated to introducing the surgical instruments needed for decompression and discectomy.
This separation between the visual channel and the operative channel gives the surgeon greater freedom of movement compared with the single-portal technique. The instruments can be maneuvered with a wider range of angles and with movements more similar to those of traditional surgery, while still maintaining the advantages of minimal invasiveness.
Using the bi-portal technique, it is possible to remove herniated disc fragments, decompress nerve roots, enlarge the vertebral foramina and, in selected cases, treat even more complex degenerative stenosis.
How the procedure is performed
The procedure can be performed under general anesthesia or, in certain selected cases, with other anesthesiological techniques, depending on the site of the condition, the expected duration and the patient’s clinical condition.
The patient is generally positioned to allow safe access to the spinal segment to be treated. After precisely identifying the affected level through intraoperative radiological guidance, one or two small skin incisions are made, depending on the technique chosen.
Through the endoscope, the surgeon visualizes the affected anatomical structures, identifies the compressed nerve root and proceeds with decompression. If a disc herniation is present, the fragment responsible for the compression is selectively removed. If the cause is instead stenosis, portions of thickened ligament, bone tissue or other structures reducing the space available for the nerve roots may be removed.
Advantages of endoscopic surgery
One of the main advantages of endoscopic discectomy and decompression is the reduced surgical trauma to the paravertebral muscles. The incisions are small and access to the tissues is targeted, with less need for muscle dissection compared with traditional techniques.
This can result in less post-operative pain, reduced blood loss, smaller scars, earlier mobilization and potentially faster recovery times. Endoscopic visualization also allows magnification of the surgical field and detailed visualization of the nerve and disc structures.
A further advantage is the ability to better preserve the bone and ligament structures of the spine, reducing the risk of post-operative instability in correctly selected cases.
Limitations and possible complications
Despite its numerous advantages, endoscopic surgery is not indicated for all patients. Very large herniations, severe stenosis, significant vertebral instability, major deformities or complex anatomical presentations may require different or more extensive surgical techniques.
Possible complications are generally infrequent, but may include irritation or injury to the nerve root, bleeding, infection, dural tear with cerebrospinal fluid leakage, persistent pain, recurrence of the disc herniation or the need to convert to a traditional surgical technique.
In bi-portal techniques, the use of continuous irrigation requires careful control of pressure and fluids, to avoid complications related to fluid accumulation in the surrounding tissues.
Post-operative course
Recovery after endoscopic discectomy or decompression is often faster than with traditional surgery, especially in cases of simple disc herniation. The patient can be mobilized early, often within a few hours or the day after the procedure, according to the surgeon’s instructions.
The length of hospital stay varies depending on the procedure performed, the patient’s general condition and the post-operative clinical response. In many cases, the hospital stay can be short.
Radicular pain can improve quickly, while any tingling, altered sensation or muscle weakness may require longer recovery times, especially if the nerve compression had been present for a long time.
Convalescence
Treatment goal
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