Herniated Disc: Endoscopic Low Back Partial Disc Removal—Interlaminar Approach

Herniated Disc: Endoscopic Low Back Partial Disc Removal—Interlaminar Approach

This surgical video demonstrates the partial removal of a herniated disc in the lower back using an endoscope through an interlaminar approach. When the central portion of a disc in the lower back herniates or breaks through the outer portion, it can put pressure on the spinal cord or nerve roots that exit from the spinal cord. This often results in nerve pain that travels down the legs. A partial disc removal, also called a discectomy, removes the part of the herniated disc causing nerve compression, while keeping the rest of the disc in place. This procedure can be performed endoscopically with a small incision, where surgical instruments are inserted through a small tube, called an endoscope, that contains a light, a camera, and a channel for tools to pass through.

This surgery will be performed with an interlaminar approach, where the herniated disc is accessed through the central opening between 2 vertebrae in the back of the spine. Here we see a patient lying face down with their head toward the right side of the screen and their feet toward the left side of the screen. The surgeon begins the procedure by using x-ray to find the central opening between 2 vertebrae in the back of the spine. The surgeon makes a small incision in the skin and inserts a surgical instrument to create and confirm the correct path for the endoscope. The surgeon then places a metal tube, called a cannula, over the instrument, and the instrument is removed.

The surgeon then passes the endoscope into the cannula to view inside the spine. Here is the view through the camera from the endoscope, showing fatty tissue covering the opening in the spine. The surgeon clears away the fatty tissue to see the ligament that covers the backside of the spinal canal, called the ligamentum flavum. Then, the surgeon cuts through this ligament carefully to access the spinal canal. Next, the cannula is pushed into this space. More fat is removed, and the nerve root and the disc are identified.

The surgeon uses an instrument to free up the nerve root, allowing them to see the nerve and the disc more clearly. Then, they twist the cannula to move the open angle away from the nerve root and toward the disc. The surgeon will use small instruments to remove some of the thicker, outer layer of the disc, followed by small portions of the herniated disc material. The surgeon then confirms that the compression on the nerve root has been relieved. The surgeon removes the endoscope and cannula and will close the skin incision with sutures. The procedure is now complete.