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

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

This animation 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 the spine of the lower back from the side. With the patient lying on the operating table face down, the patient's head is toward the left side of the screen, and the patient's feet are toward the right side of the screen. Looking inside the spine, we can see a herniated disc pressing on a nerve.

First, x-rays are taken during surgery to help guide the placement of a needle into the central opening between 2 vertebrae in the back of the spine. A guidewire is then inserted through the needle, and the needle is removed. A series of metal tubes are then placed over the guidewire to slowly stretch an opening for the endoscope.

Here we see the view from the camera from the endoscope. This is a view of the spine from the top down, where we can see the herniated disc pushing into the spinal cord and nerve root. A small blade is inserted through the endoscope and is used to cut through a ligament, called the ligamentum flavum, that covers the backside of the spinal canal. This allows the endoscope to access the affected area.

The nerves are carefully moved to the side to see the herniated disc. Small instruments are used to carefully remove the herniated disc and repair the outer layer of the disc. Once the compression is relieved, the skin incision is closed with a suture, a dressing is applied, and the procedure is complete.