Micro Endoscopic Discectomy (MED)

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Micro Discectomy - What is it

Through advancements in modern surgical technology surgeons worldwide have started performing a surgical procedure called a micro endoscopic discectomy (MED). The operating surgeon uses special instrumentation combined with a real-time camera display to remove a herniated disc or fragments of one through a very small incision.

A microscopic discectomy is performed for the same reasons as a traditional discectomy to accomplish the same results. An endoscopic microdiscectomy is performed to remove a herniated disc by using much smaller incisions. In a traditional discectomy your surgeon makes a large enough incision which he can visually see and remove herniated disc fragments. In a micro discectomy your surgeon will use small incisions combined with a small camera to locate the problematic fragment(s) and remove them with special surgical instruments. The procedure may or may not require general anesthesia and because it is done with a smaller incision there is usually less tissue damage.

There are only specific situations where an endoscopic microdiscectomy is viable. Many patients seeking surgical procedure are better suited to a traditional discectomy, or other minimally invasive surgery. Although the thought of a faster and easier recovery may sound enticing, the important thing to remember is the surgery must be performed properly.

MED (Micro Endoscopic Discectomy) Procedure

In most cases the patient will be “put under” with general anesthesia, but some surgeons prefer to perform a MED using either local or spinal anesthesia alleviating some patient uneasiness and concerns about general anesthesia. With the patient sedated he/she is turned onto their abdomen and secured into position with pads. A fluoroscope is used during the procedure to show live X-ray pictures on a monitor, helping the surgeon see what fragments need to be removed.

Using the fluoroscope the team confirms the disc space and injects an extended duration local anesthetic through the muscle and around the bone that protects the disc. With the use of a wire and varying sizes of dilators the incision is progressively enlarged without the need to cut any muscle. It will usually take four to five dilators for the incision to enlarge to roughly the size of a nickel, which will be used as the entry point for the procedure. When the final dilator is in place, a circular retractor is placed into position to create a working channel. Once the working channel is in place all the dilators are removed.

The endoscope is then attached and positioned to the edge of the channel that was just created allowing the surgeon to operate via images projected to a TV screen. The rest of the procedure is performed through the working channel.

Once the procedure is completed the wound is flushed with antibiotics. As the fluoroscope is removed your surgeon will be able to see how the tissue is coming together and place stitches to help hold the tissues together at various levels, promoting better healing.

Typically a few stitches are used on the exterior of the wound and a loose bandage is secured. After a few hours of monitoring in the recovery room, if everything goes well, the patient is allowed to leave the hospital. All that is left is for the patient to continue follow up appointments and start recovering from the procedure.

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