Endoscopic abrasion

The novel surgical treatment option for regeneration of pain causing degenerative lumbar disks.

Every chronification of pain is a challenge for the treating physician. If conservative treatment options – like physiotherapy, electro- or thermal therapy, and analgesic pain management - do not relieve symptoms within 6 to 8 weeks, a differentiated analysis of the underlying causes of pain is necessary.

 If back pain lasts more than 6 weeks it is considered chronic.

If with an MRT or CT image there is still no sufficiently precise diagnosis possible, a discography of the affected spinal disks might be indicated. With these methods, fissures in the outer fibrous ring (anulus fibrosus) of the disk may be detected. In some cases it might be required to combine discography and computed tomography. If a rupture of the spinal disk is diagnosed, a percutaneous nucleotomy might be an appropriate therapeutic option. In cases of significant degeneration of not more than one or two spinal disks, helpful interventions might be discoplasty (endoscopic decompression and refreshing of the disk), an artificial disk replacement or a spondylodesis. Which of these options applies has to be considered carefully.

How is surgery carried out?

Under local anesthesia an optical endoscope is inserted through a small skin incision. It is equipped with different tiny working channels and can be carefully pushed forward to the affected spinal disk. Under sight-control the calcified ground and end plate of the adjacent vertebral bodies are abrased with minute instruments. This leads to a better blood supply of the disk tissue and a firm and stable fibrous ring can develop.

The intervention takes 30 to 45 minutes. The entrance point will be aseptically closed with a small patch.

Subsequently the patient will be monitored for 2 hours in the recovery room. With good general condition out-patient surgery is possible.

The next day and then again after three months there will be follow-up examinations. 

What post-operative care is necessary?

 There will be a follow-up examination the day after the intervention. Additionally a physiotherapist will explain to you an individually targeted rehabilitation program. During the first two weeks you will have to put on a specially fitted plastic corset that sustains your back and will soon allow for resuming daily activities. It is recommended to start a professionally supervised physiotherapy after one week. After 6 weeks, strengthening exercises for your back and abdominal muscles should be started. Simultaneously you might gradually resume your sports activities.

For further reading on the postoperative care after a discectomy you may want to download our brochure “postoperative care”. 

When may I resume my sports activities?

After about three weeks you should be able to go swimming or to ride your bicycle. Your may resume your usual sports activities after 6 weeks.

When can I go back to work?

After one to two weeks you can resume simple office work and slight physical work. You shouldn’t do any hard physical work during the first 6 weeks and then only gradually increase.

What is the success rate?

”Gold standard” treatment for diseases resulting from a degenerative and pain causing spinal disk is the insertion of an artificial disk replacement or a spondylodesis (fusion or stiffening surgery) with all associated advantages, disadvantages and complications.

Hence our minimally invasive approach represents a therapeutic trial. There are no valid national or international clinical study results on the endoscopic surgery (diskoplasty) for this indication. In an own study with a two year follow-up good or excellent outcome in 75% of patients could be demonstrated. This option hence prevented those patients from an artificial disk replacement or a fusion surgery (Source: M. John et al: Percutaneous transforaminal endoscopic disk abrasion as a therapy for the regeneration of painful degenerative lumbar spinal disks. 2007, Dissertation, TH Aachen, 2007).

All advantages at a glance:
  • The intervention can be carried out under local anesthesia – no general anesthesia is required!
  • As there is almost no tissue damage, the intervention is much less cumbersome and the risk of complications is very low
  • No instability, as the structures that stabilize the spine – the ligaments and joints – remain unhurt. This is a main difference to microscopic surgery technique.
  • Less wound healing pain as well as higher stability, as back muscles are not torn or cut
  • Little infection risk, as access is through a small cutaneous incision (5mm)
  • Less scarring in the region of the nerve roots!
  • Already two hours after the intervention you will be able to walk without pain
  • Short hospital stay: you can go back home the day after the intervention
  • Already after a few days you may resume your usual daily activities
  • Short recovery times: after one or two weeks you can go back to work, after 6 weeks you may resume your usual sports activities.
  • Little scarring

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Reviews

I needed to tell just one sentence and diagnosis was established and then also confirmed by imaging techniques. Neither the orthopedic specialist nor the radiologist I had visited before, had identified the herniated disc. They told me to do some sports and that surgery would not help. Immediately after the surgery in the ATOS clinic, my symptoms disappeared and I was also pain free. Absolute number 1 address for spinal disc problems.

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