Role of endoscopy in traumatic disc prolapse

Dr Abrar Ahad Wani

MS; MCh (SGPGI)
Fellowship Fujita heath university( Japan)
Fellowship in endovascular surgery (GBPGIMER)
Additional Professor
Department of neurosurgery
Sher-i-kashmir institute of medical sciences
 Low backache
• A major public health problem

• The leading cause of disability for people < 45

• 2nd leading cause for physician visits

• 3rd most common cause for surgical procedures

• 5th most common reason for hospitalizations

• Lifetime prevalence: 49%–80%

Pai et al. 2004, Orthop Clin N Am

• Trauma forgotten etiology of disc prolapse
Posture and intradiscal pressure
 Pathophysiology
• Nucleolus pulposus: Type II collagen strand +
hydrophilic proteoglycan
• Water content 70 ~ 90%
• Confine fluid within the annulus
• Convert load into tensile strain on the annular
fibers and vertebral end-plate
 • Nucleus pulposus-water rich, gelatinous,axial load, pivotal point,binds
vertebrae together
• Annulus fibrosus-fibrous and tougher, less water content,contains the
nucleus pulposus

normal

Disc prolapse

Disc extrusion
Disc sequestration
 Presentation
Sciatica
- radiating pain down the leg

Back Pain
• change in disc loading and shape, biomechanics
• loss of viscoelasticity.
• 90% of radiating pain have long-standing prior
episodic low back pain
MRI disc extrusion
 Lumbar Disc Herniation – Treatment

Conservative Tx. Surgical Tx.

– Moderate bed rest Conventional :
– Medication • Laminectomy
&discectomy
• NSAIDs • Microdiscectomy
• Muscle relaxants • Endoscopic
• Rarely narcotics discectomy
 Indication of Surgery

Absolute surgical indication

• Cauda equina syndrome
acute urinary retention/incontinence,
saddle anesthesia, back/ buttock/ leg pain, weakness,
difficulty walking

Relative indication
• No response to conservative treatment
Conventional approach
 ENDOSCOPIC APPROCHES
• INTERLAMINAR
Destaundau
Easy go
• TRANSFORAMINAL
• EXTRAFORAMINAL
Representative cases
 DISADVANTAGE

• Long and steep learning curve .

• More extensive bony resections are
technically more
 ADVANTAGES
• Excellent visual conditions and short operation times.
• Preservation of epidural lubricating tissue, reduced
epidural scarring, and avoidance of a post-discectomy
syndrome.
• Minimized resection of bone and ligaments, possible
reduction of surgery-induced instabilities.
• Subsequent operations are not made more difficult.
• No surgery-related increase in back pain.
• Short hospitalization, rapid rehabilitation, high
rate of return to earlier level of activity in sports.
• High patient acceptance
• Take home message
• Everybody has a limit upto which his spine can
bear stress
• Acute traumatic disc prolapse had dramatic
presentation
• MRI is diagnostic modality of choice
• Endoscopic discectomy is a new minimally
invasive tool for management
• Advantages of Endoscopic discectomy:
• Less than half of an inch incision
• Go home the same or next day
Thank you for your attention