Full-Endoscopic Lumbar Hernia Surgery

Differences from Traditional Surgical Methods

Minimally invasive surgery is a technique performed with incisions only a few millimeters in size. In traditional surgical methods, large incisions are made to access the spine, causing more damage to muscles, ligaments, and other soft tissues. In contrast, the small incision used in endoscopic discectomy preserves surrounding tissues and minimizes tissue damage.

• Smaller incisions: Incisions made during endoscopic discectomy are typically 1–2 centimeters in length, compared to the 5–10 centimeter incisions required for traditional open surgeries.
• Less muscle and tissue damage: In traditional methods, muscles are separated to expose the spine, whereas such procedures are not needed in endoscopic surgery. This preserves the muscles and soft tissues, resulting in less postoperative pain and faster recovery.
• Direct intervention: With endoscopy, surgeons can directly target the herniated disc without exposing a larger area, as in traditional surgery. This reduces tissue trauma significantly.

1. Postoperative Recovery Process

Full-endoscopic lumbar hernia surgery significantly accelerates the recovery process compared to traditional methods. Its minimally invasive nature results in less tissue damage, allowing the body to heal faster. While recovery from traditional surgeries may take weeks or months, patients undergoing endoscopic discectomy can often return to light activities within a few days.

• Rapid recovery: Patients who undergo endoscopic discectomy can usually be discharged within 24 hours. In contrast, traditional surgery often requires a hospital stay of several days, allowing patients to return to their daily lives and work sooner.
• Less pain: Smaller incisions and minimal tissue damage reduce postoperative pain. Since there are no large incisions, patients experience less discomfort during recovery and typically require shorter-term use of pain medications.
• Shorter physical therapy duration: Traditional surgery may require prolonged physical therapy, whereas patients undergoing endoscopic discectomy can return to normal activities after a brief physical therapy program.

2. Lower Risk of Bleeding and Infection

Endoscopic surgery carries a much lower risk of infection and bleeding compared to traditional open surgery. This can be attributed to several factors:

• Smaller incisions mean less bleeding: Larger incisions in traditional surgery can lead to significant blood loss. However, the small incisions in endoscopic surgery result in minimal bleeding, often eliminating the need for blood transfusions during the procedure.
• Reduced infection risk: Endoscopic surgery involves intervention in a smaller area, significantly reducing the risk of postoperative infection. The small incisions make it harder for environmental pathogens to enter the body, minimizing the likelihood of infections.
• Faster wound healing: Small incisions heal quickly, requiring minimal wound care. Unlike large incisions, they do not require extensive dressing and have minimal impact on the patient’s daily life during recovery.

3. Fewer Postoperative Complications

In traditional open surgical methods, the muscles, bones, and tissues surrounding the spine may sustain more damage, potentially leading to long-term complications. Endoscopic discectomy minimizes these risks.

• Lower risk of nerve damage: Endoscopic surgery provides a clearer view of the spinal cord and nerve roots, reducing the risk of nerve damage. Traditional surgery, on the other hand, may place greater pressure on the nerve roots, increasing the risk of nerve injury.
• Lower risk of tissue scarring: Less tissue damage during endoscopic surgery minimizes the formation of scar tissue and related complications. Traditional surgery, with larger incisions and more tissue trauma, carries a higher risk of scarring and associated pain.
• Reduced risk of recurrence: The minimally invasive nature of the procedure lowers the likelihood of lumbar hernia recurrence. In traditional surgery, scar tissue formed during healing can press on the nerve roots again, increasing the recurrence rate.

Who is Full-Endoscopic Lumbar Hernia Surgery Suitable For?

Full-endoscopic lumbar hernia surgery (full-endoscopic discectomy) is suitable for patients whose herniated disc exerts pressure on the nerve roots and causes severe symptoms. This method is preferred when the herniated disc is large enough to require surgical intervention. Thanks to its minimally invasive nature, the procedure is performed with minimal damage to surrounding tissues and nerve roots. Below are the general characteristics of patients eligible for the surgery:

1. Patients with Moderate to Large Disc Herniations

A disc herniation or lumbar hernia occurs when the discs between the vertebrae rupture and protrude outward, compressing the nerve roots. This compression can cause severe pain, numbness, and muscle weakness, making it difficult for patients to perform daily activities.

• Moderate disc herniation: In cases where the disc is slightly herniated and compressing the nerve roots, patients often experience pain, numbness in the legs, and difficulty walking. If symptoms do not improve with non-surgical methods such as physical therapy or medication, full-endoscopic lumbar hernia surgery is recommended.
• Large disc herniation: This method is highly effective when a larger portion of the disc protrudes outward and significantly compresses the nerve roots. The surgery relieves pressure on the nerve roots, quickly alleviating the patient’s symptoms.

2. Patients Experiencing Severe Pain Due to Nerve Compression

In patients with lumbar hernia, compression of the nerve roots by the herniated disc can lead to severe pain. This pain often starts in the lower back and radiates down to the legs (radicular pain), significantly limiting the patient’s mobility.

• Pain adversely affecting daily life: Severe pain radiating to the legs in lumbar hernia patients can make basic activities like sitting, standing, or walking extremely difficult. If such pain cannot be alleviated with non-surgical methods like medication or physical therapy, full-endoscopic lumbar hernia surgery is recommended.
• Pain unresponsive to medication: Pain that cannot be managed with pain relievers and anti-inflammatory medications suggests more serious nerve compression. In such cases, endoscopic discectomy quickly relieves the pressure on the nerve, eliminating the pain.

3. Patients Whose Symptoms Do Not Improve with Non-Surgical Treatments

In the treatment of lumbar hernia, non-surgical methods are usually tried as the first line of intervention. Methods such as physical therapy, injections, and medications aim to alleviate symptoms. However, these treatments may not always be sufficient.

• Patients unresponsive to physical therapy: Physical therapy aims to strengthen the muscles and relieve pressure on the spine. However, for some patients, this approach may not be sufficient to alleviate nerve compression.
• Patients whose pain persists despite injections and medication: While corticosteroid injections and pain relievers provide short-term relief, they do not eliminate nerve root compression in the long term. In such cases, surgical intervention is required.

4. Patients Experiencing Neurological Deficits Due to Lumbar Hernia

As lumbar hernia progresses, nerve root compression can lead not only to pain but also to neurological deficits. These neurological deficits are a sign of significant nerve damage and require urgent surgical intervention.

• Muscle weakness: Compression of the nerve roots can cause muscle weakness in the legs and feet. Patients may have difficulty lifting their legs or feel weakness in their ankles. This indicates the need for intervention before permanent damage to the nerve roots occurs.
• Numbness and loss of reflexes in the legs: Severe nerve root compression can result in numbness in the legs and reduced reflexes. Patients may experience tingling or complete numbness in their feet. These symptoms indicate significant nerve compression and the necessity for surgical intervention.

5. Emergency Conditions Such as Cauda Equina Syndrome

Though rare, some lumbar hernia cases can lead to emergency conditions like cauda equina syndrome. In this syndrome, the lumbar hernia places significant pressure on the lower portion of the spinal cord nerves, causing serious neurological issues such as urinary incontinence, loss of bowel control, sexual dysfunction, and complete loss of sensation in the legs. Such cases require immediate surgical intervention, and full-endoscopic lumbar hernia surgery can provide an effective solution for these patients.

Steps of Full-Endoscopic Lumbar Hernia Surgery

Full-endoscopic lumbar hernia surgery (full-endoscopic discectomy) is a minimally invasive surgical technique performed using advanced technology. This procedure is aimed at relieving nerve compression caused by the herniated disc and alleviating the patient’s pain. The step-by-step process of the surgery ensures the surgeon’s precision while enabling faster and more comfortable recovery for the patient. Here are the steps involved in full-endoscopic lumbar hernia surgery:

1. Administration of Anesthesia

Full-endoscopic lumbar hernia surgery is typically performed under local anesthesia. Local anesthesia ensures complete numbness of the surgical area while the patient remains awake during the procedure. This allows the patient to provide feedback about the condition of their nerve roots, aiding the surgeon in performing the operation with greater precision. In some cases, general anesthesia may be preferred based on the patient’s preference or the complexity of the surgery. Under general anesthesia, the patient is fully sedated and feels no sensation during the procedure.

• Advantages of local anesthesia: Local anesthesia allows for faster postoperative recovery. Additionally, it avoids potential side effects associated with general anesthesia.
• Situations where general anesthesia may be preferred: General anesthesia is recommended in cases where the patient is anxious, has a low pain threshold, or if the surgery may become more complex.

2. Placement of the Endoscope

One of the most critical steps in the surgery is the placement of the endoscope. The surgeon makes a small incision a few millimeters in size in the lumbar region and inserts the endoscope into the spinal canal through this incision. The endoscope is equipped with a high-resolution camera that magnifies the spinal structures on a screen, allowing the surgeon to obtain a detailed view. This enables the surgeon to clearly see the herniated disc and nerve roots.

• High-resolution imaging: The endoscopic camera provides detailed visualization of the spinal canal and nerve roots. This allows the surgeon to work with great precision and intervene only in the herniated area.
• Minimal incision: The incision for placing the endoscope is very small, leading to a shorter wound healing time and providing a significant aesthetic advantage.

3. Removal of the Herniated Disc

Using the endoscopic camera, the surgeon removes the herniated disc with microsurgical instruments. This process involves removing the disc fragments that are compressing the nerve root. Once the herniated disc is removed, the pressure on the nerve is relieved, and the nerve is decompressed. This results in the rapid improvement of the patient’s pain and other symptoms.

• Microsurgical instruments: The surgeon uses fine microsurgical instruments to remove the herniated disc material. These instruments operate with precision under the guidance of the endoscopic camera, ensuring no harm to the surrounding tissues while targeting only the problematic area.
• Nerve root decompression: Relieving the pressure on the nerve root immediately alleviates the patient’s pain and starts improving neurological symptoms rapidly.

4. Completion of the Surgery

After removing the herniated disc material and relieving the pressure on the nerve, the endoscope is withdrawn. The surgeon closes the small incision made during the surgery with a few stitches. Thanks to its minimally invasive nature, the postoperative recovery process is very quick. Patients can usually start walking within a few hours after the surgery and are discharged the same day or the day after.

• Minimally invasive nature: The minimal damage to surrounding tissues allows patients to return to their daily lives quickly.
• Quick discharge: Patients can typically get up and walk a few hours after the surgery and be discharged. The hospital stay duration is very short for full-endoscopic lumbar hernia surgery.

5. Duration of Surgery

The surgery typically lasts between 45-60 minutes. This duration may vary depending on the size of the herniated disc and the surgeon’s experience. This short surgical procedure is performed very safely thanks to its minimally invasive nature and the use of advanced technology.

6. Technology and Instruments

The endoscopic camera and microsurgical instruments used in full-endoscopic lumbar hernia surgery allow the surgeon to view the herniated disc and intervene with precision. These modern technologies increase the success rate of the surgery and minimize the risk of complications.

• Endoscope: The most critical piece of equipment for the surgery. The endoscope, equipped with a high-resolution camera, enables the surgeon to clearly view the structure of the spine.
• Microsurgical instruments: These instruments, used alongside the endoscopic imaging, work with extreme precision to remove the herniated disc and relieve the nerve roots. They allow targeted intervention without damaging surrounding tissues.

Postoperative Period

After surgery, patients can walk within a few hours and return to light daily activities within a few days. The small incisions made during the surgery allow for rapid wound healing and carry a low risk of complications. However, it is recommended to avoid heavy activities for 4-6 weeks.

Recovery Period After Full-Endoscopic Lumbar Hernia Surgery

The recovery process following full-endoscopic lumbar hernia surgery (full-endoscopic discectomy) is fast and comfortable due to the minimally invasive nature of the procedure. However, recovery can vary depending on the patient’s health condition, the scope of the surgery, and postoperative care. In general, patients can return to their daily lives shortly after surgery, but there are certain steps to ensure a full recovery.

1. Rest During the Initial Days

Resting during the first few days after surgery is crucial. However, complete immobility is not recommended. Light walking is encouraged to promote blood circulation in the surgical area and accelerate recovery.

• First few days: Patients should prioritize bed rest during the initial days after surgery. However, short and slow walks during this period help increase blood circulation and contribute to recovery. Prolonged immobility is not recommended as it may lead to complications like blood clots.
• Proper positioning during rest: While resting, it is important to support the back and avoid putting excessive pressure on the lumbar region. Patients should follow the recommended sitting and lying positions advised by their doctor.

2. Light Exercises During the First Week

Starting light exercises during the first week after surgery is a critical step to strengthen muscles and improve spinal stability. These exercises help maintain proper spinal alignment and prevent muscle weakening post-surgery.

• Walking: Short walks several times a day are recommended. These slow-paced walks activate the muscles around the spine, improve blood circulation, and strengthen leg muscles.
• Neck and back exercises: Light neck and back exercises recommended by the surgeon after surgery help maintain proper spinal alignment and strengthen the muscles. These exercises should be performed without straining the spine and avoiding sudden movements.

3. Return to Daily Life

The recovery process after full-endoscopic lumbar hernia surgery is significantly faster compared to traditional surgeries. Patients can typically return to their daily routines within a few days after surgery, but it is important to avoid heavy physical activities.

• Returning to work within 1-2 weeks: Patients with light-duty jobs can usually return to work within 1-2 weeks. However, if the job involves physical demands, this period may be longer. For example, desk job workers may return sooner, while those with physically demanding jobs may need extended rest.
• Avoiding heavy activities: For the first 4-6 weeks after surgery, activities such as heavy lifting, bending, strenuous physical tasks, and sports should be avoided. Heavy activities can put pressure on the surgical site, prolonging the recovery process and causing complications.

4. Physical Therapy and Rehabilitation

Physical therapy and rehabilitation programs after full-endoscopic lumbar hernia surgery help strengthen muscles and improve spinal stability. The physical therapy process is initiated as per the program set by the surgeon and is adjusted based on the patient’s condition.

• Muscle strengthening: Physical therapy focuses on strengthening the back and lumbar muscles post-surgery. Stronger muscles reduce the pressure on the spine and accelerate recovery.
• Balance and posture training: During the rehabilitation phase, patients are trained to maintain proper spinal alignment through balance and posture education. Correct posture and movement habits are crucial for maintaining spinal health.
• Personalized exercise program: A personalized exercise program is created during physical therapy based on the patient’s overall condition and needs. These programs aim to strengthen muscles and improve flexibility without straining the spine.

Comparison of Full-Endoscopic Lumbar Hernia Surgery with Other Surgical Methods

Full-endoscopic lumbar hernia surgery (full-endoscopic discectomy) is a modern surgical method preferred for lumbar hernia treatment due to its minimally invasive nature. However, there are other surgical methods used for lumbar hernia treatment, including traditional open surgery and microscopic discectomy. Compared to these methods, full-endoscopic lumbar hernia surgery offers several advantages. Here is a detailed comparison of these methods:

1. Open Surgery

Open surgery is an older and more invasive method used in the treatment of lumbar hernia. This method requires large incisions, allowing the surgeon direct access to the spine. However, extensive tissue intervention is associated with higher risks and a longer recovery process.

• Incision size and tissue damage: Open surgery involves large incisions, leading to greater damage to muscles and soft tissues. Reaching the spine may require the separation or cutting of muscles, extending the recovery period.
• Recovery time: The recovery period after open surgery is generally long. The hospital stay and return to normal activities may take weeks or months. Due to the greater tissue damage, postoperative pain and complications are more common.
• Risk of complications: Due to large incisions and the invasive nature of the procedure, risks such as infection, bleeding, and nerve damage are higher in open surgery. Additionally, scar tissue formation is more frequent.
• Hospital stay duration: After open surgery, patients generally need to stay in the hospital for a few days. This duration may be extended depending on the patient’s overall condition and the complexity of the surgery.

2. Microscopic Discectomy

Microscopic discectomy is a minimally invasive surgical method used for the treatment of lumbar herniated discs. The surgeon uses a microscope to clean the herniated disc compressing the nerve root through a small incision. Although microscopic discectomy is more invasive than full-endoscopic lumbar surgery, it causes less tissue damage compared to open surgery.

• Incision size: Microscopic discectomy requires a much smaller incision compared to open surgery. However, the incision is slightly larger than that of a full-endoscopic lumbar surgery, resulting in a slightly longer recovery period.
• Microscope usage: This method is performed with the aid of a microscope, allowing the surgeon to clearly view the spinal structure. While microscopic surgery enables more precise intervention on the nerve root, it does not offer the 360-degree field of view provided by endoscopic surgery.
• Risk of complications: The risks of nerve damage and infection are minimal but higher compared to full-endoscopic surgery. Nevertheless, microscopic discectomy remains a safe and effective method.
• Recovery period: The recovery period after microscopic discectomy is longer than that of full-endoscopic lumbar surgery but shorter compared to open surgery. Patients can typically return to light activities within a few weeks.

3. Full-Endoscopic Lumbar Surgery (Full-Endoscopic Discectomy)

Full-endoscopic lumbar surgery is a modern surgical method that incorporates all the advantages of minimally invasive surgery. The endoscopic camera used during the procedure allows the surgeon to see the herniated disc and nerve roots in greater detail, enabling precise and effective intervention.

• Incision size: During endoscopic discectomy, small incisions measuring only a few millimeters are made. This minimizes damage to surrounding tissues and results in much faster postoperative tissue healing.
• Hospital stay duration: Patients undergoing full-endoscopic lumbar surgery can typically be discharged on the same day. The short hospital stay significantly contributes to faster recovery.
• Risk of complications: This method minimizes the risks of infection, bleeding, and nerve damage due to its minimally invasive nature. Furthermore, since no large incisions are made, scar tissue formation is extremely rare.
• Recovery period: Full-endoscopic lumbar surgery offers one of the fastest recovery times among surgical methods. Patients can return to light activities the day after surgery and achieve full recovery within a few weeks. Compared to open surgery, patients can resume their daily routines much sooner.

Advantages of Full-Endoscopic Lumbar Surgery

Full-endoscopic lumbar surgery offers numerous advantages compared to both open surgery and microscopic discectomy. These benefits accelerate the recovery process while reducing the risk of complications.

• Smaller incisions: Endoscopic surgery is performed through incisions of only a few millimeters. This minimizes tissue damage, reduces scar tissue formation, and allows for a much faster recovery.
• Faster recovery process: Due to minimal tissue damage, patients can return to work and daily activities much faster. Light exercises and daily activities can be initiated within a few days after surgery.
• Lower risk of complications: The risks of nerve damage, infection, and bleeding are significantly lower compared to other surgical methods. Additionally, since surrounding tissues are not harmed during the procedure, long-term complication risks are also reduced.
• Reduced pain: Thanks to smaller incisions and minimal muscle damage, postoperative pain is generally mild. Patients often require pain medication for only a short duration.

Conclusion

Full-endoscopic lumbar surgery stands out as a modern and minimally invasive surgical technique for the treatment of lumbar herniated discs. Compared to open surgery and microscopic discectomy, it offers advantages such as smaller incisions, less tissue damage, a faster recovery process, and a lower risk of complications. This method enables patients to quickly return to their daily lives and boasts high long-term success rates.