Diskectomy

Excerpt

Diskectomy is a surgical procedure performed to remove the herniated or damaged portion of the intervertebral disk to alleviate pressure and symptoms on the spinal nerve roots associated with lumbar disk herniation. This surgical intervention, commonly used in cases of spinal disk herniation, addresses the protrusion of the disk's inner core (nucleus pulposus) through a tear or weakness in its outer layer (annulus fibrosus), which can cause symptoms such as pain, numbness, weakness, or other neurological symptoms resulting from compression of spinal nerve roots.

Lumbar disk herniation represents a prevalent and early manifestation of lumbar spine degeneration, with reported incidences ranging from 2% to 3% and a prevalence of approximately 12%. Among individuals aged 35 or older, the prevalence is 4.8% in men and 2.5% in women. Lumbar disk herniation typically occurs at the L4-L5 and L5-S1 levels, often requiring surgical intervention and accounting for a significant portion of spinal surgeries. Initially, management approaches typically involve conservative treatments, including oral medications, rest, and physical therapy, with surgical interventions reserved for cases unresponsive to conservative measures. Physical therapists are critical in administering the gold-standard first-line treatment. Their profound understanding of human mechanics and therapeutic modalities enables the successful treatment of many disk herniations without surgery.

The historical evolution of diskectomy techniques highlights significant milestones in spinal surgery. Diskectomy involves accessing the affected disk through a small incision in the back and carefully removing the extruded disk material, thereby relieving pressure on the adjacent nerve structures. While the core principle of diskectomy surgery, aimed at alleviating nerve impingement, remains constant, newer surgical strategies prioritize minimizing trauma to the multifidus muscle and enhancing surgical visualization. This emphasis on reduced tissue disruption and improved visualization underscores advancements aimed at optimizing patient outcomes and minimizing postoperative complications.

Beginning with Mixter and Barr's description of laminectomy via the L3 to sacrum approach for lumbar disk herniation in 1934, subsequent innovations have revolutionized surgical approaches. In the 1970s, hemi-laminectomy emerged, followed by Caspar and Williams' introduction of microdiskectomy using a 3-cm incision in 1977. Wiltse and Spencer delineated the paraspinal approach for managing extraforaminal disks in 1988, coinciding with Kambin and Sampson's pioneering fully endoscopic approach. In 1993, Mayer and Brock introduced tubular retractors. Foley and Smith revolutionized the field with the microendoscopic diskectomy technique in 1997, using a video-assisted approach through a 2-cm incision, significantly minimizing tissue disruption.

Various surgical strategies are currently used for diskectomy, including open, minimally invasive open lumbar diskectomy, microlumbar diskectomy, microendoscopic diskectomy, and fully endoscopic diskectomy. These surgical procedures can significantly enhance a patient's quality of life and functional outcomes, with high success rates observed in appropriately selected cases. Later in this activity, these methods will be further elaborated upon, highlighting their respective approaches and benefits in treating disk herniation.