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Spine Treatments

Endoscopic Lumbar Laminectomy / Discectomy

The natural progression of a degenerative spine leads to lumbar disc herniation and spinal stenosis. Most patients with these conditions are treated with surgery. Lumbar disc herniation is a common manifestation of degenerative lumbar disc disease. Lumbar spinal stenosis is a progressive disease that causes changes in the spinal column that compress the spinal cord.

Lumbar endoscopic laminectomy and discectomy is a minimally invasive surgical technique designed to relieve pressure on spinal nerves and spinal cord, which can cause significant pain and disability. Full endoscopic spine surgery is the least invasive technique to treat lumbar disc herniation and spinal stenosis.

The procedure is performed using local anesthetic and sedation or general anesthesia. After making a small incision, Dr. Ball will insert an endoscope, under fluoroscopic X-ray guidance, into the incision to visualize the spine. Using tiny instruments, he will remove a small portion of the lamina. This bone covers the spinal cord (laminectomy) or disc material, compressing the nerve root (discectomy) to provide more room for the nerve or spinal cord to heal.

The endoscope causes only minimal disruption of the muscles and soft tissues, which permits a quicker recovery compared to traditional open spine surgery. Once the decompression is achieved, the instruments are withdrawn, and the incision is closed with sutures or surgical staples.

  • Spinal Stenosis: Spinal stenosis is a spinal canal narrowing, often due to aging, which can compress the spinal cord and nerves. It is the most common indication for a laminectomy.
  • Foraminal Stenosis: This condition involves narrowing the openings where nerves leave the spine, causing nerve compression. A laminectomy provides access to enlarge these openings and relieve nerve pressure.
  • Herniated Disc: While a discectomy is typically the primary surgical focus for a herniated disc, a laminectomy may also be performed when the herniated disc is causing compression on the spinal nerves.
  • Degenerative disc disease: As the intervertebral discs degenerate, they can cause changes in the spine’s structure, including the formation of bone spurs and narrowing of the spinal canal. A laminectomy is required to relieve pressure on the spinal canal.

A laminectomy is generally considered when more conservative treatments, such as physical therapy, medications, or injections, have not adequately relieved symptoms of pain, numbness, and weakness or when there is a significant risk of permanent nerve damage. The goal of the procedure is to provide more space within the spinal canal to alleviate pressure on the spinal cord or nerves, thus reducing pain and improving function.

A discectomy is typically considered when conservative treatments such as physical therapy, medications, and spinal injections fail to relieve symptoms. The procedure can be performed as a traditional open surgery. Still, more commonly now, it is done using minimally invasive techniques, which can reduce recovery time and the risk of complications. The primary goal is to relieve nerve compression and the associated symptoms, improving the patient’s quality of life.

Recovery from endoscopic spine surgery tends to be faster and less painful than that from traditional open spine surgery, mainly due to the minimally invasive nature of the procedure. Many endoscopic spine surgeries are performed outpatient, meaning the patient can go home the same day. However, overnight stays may be required depending on the specifics of the surgery and the patient’s overall health.

Pain management is common but much less severe than with open surgery. Pain may be initially managed with prescription pain medications, but over-the-counter pain medicines may be sufficient. Physical therapy is advised to improve mobility and strengthen the back and abdominal muscles. Patients can usually return to light activities within a few weeks. However, returning to more strenuous activities or jobs that involve heavy lifting may take longer, usually several months. Dr. Ball will provide guidance based on the patient’s progress.

Contact Dr. Hieu Ball to schedule a consultation at his San Ramon. He offers a full range of treatments for neck pain. Dr. Ball offers state-of-the-art patient-centered care for patients with neck, mid-back, and low-back problems. He received his orthopedic and spine surgery residency and fellowship training at Harvard Medical School and UCLA-affiliated institutions. Education included training at Massachusetts General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. Dr. Ball is a double fellowship-trained orthopedic spine surgeon. He received a pediatric spine fellowship at Boston Children’s Hospital and a second adult spine fellowship at UCLA. Dr. Ball offers minimally invasive spine care, and many procedures often may be performed on an outpatient basis in an ambulatory surgical center setting.

References

  • Estefan M, Munakomi S, Camino Willhuber GO. Laminectomy. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.¬†Available from: https://www.ncbi.nlm.nih.gov/books/NBK542274/
  • Kao FC, Hsu YC, Wang CB, Tu YK, Liu PH. Short-term and long-term revision rates after lumbar spine discectomy versus laminectomy: a population-based cohort study. BMJ Open. 2018 Jul 17;8(7):e021028. doi: 10.1136/bmjopen-2017-021028. PMID: 30018095; PMCID: PMC6059274.
  • Gadjradj PS, Fiani B, Sommer F, Ramirez RN, Harhangi BS. Expanding indications of full endoscopic spine surgery. J Spine Surg. 2023 Sep 22;9(3):229-232. doi: 10.21037/jss-23-65. Epub 2023 Jun 27. PMID: 37841778; PMCID: PMC10570651.
At a Glance

Dr. Hieu Ball

  • Double fellowship-trained orthopedic
  • Orthopedic surgery residency at Harvard Medical School
  • Over 20 years of spine surgery experience
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