Surgery Takes to the Big Screen: Video Technology for Disc HerniationBetween the bones of the spine is a round cushion called the intervertebral disc. The material within the disc can rupture or herniate, putting pressure on nearby spinal nerves. The result is pain and possibly damage to the nerves. The pain may travel down the arm or leg, depending on whether the herniation is in the neck or low back.
Disc herniation usually occurs in the low back, but it can happen anywhere along the spine. Treatment depends on the location of the herniation. Treatment usually begins with anti-inflammatory medication, rest, physical therapy, and nerve blocks. Surgery is an option in some cases.
Surgery is more difficult when the herniation occurs in the middle of the back, or the thoracic spine. Various ways to reach the damaged disc have been tried. A new method called video-assisted thoracoscopic surgery (VATS) is being studied. With this procedure, the patient is positioned on his or her side, slightly tilted forward. The doctor collapses the lung and inserts a tool called an endoscope between the ribs. The endoscope is a flexible tube with a camera on the end that allows the doctor to see inside the body. Using the endoscope, the doctor can find the disc herniation and remove it. Sometimes the doctor will also fuse the bones above and below the injured disc. Finally, the collapsed lung is inflated. The VATS procedure works best for patients who have not had disc surgery before. Patients with the most severe symptoms before surgery often have the best results after surgery.
A new surgery is available for disc herniation in the mid-back area. Using video technology, this surgery only requires a few small incisions rather than fully opening the ribcage. There is less blood loss, less time in the hospital, and less pain. More research is needed to perfect this new method, but the early results are very good.
Neel Anand, MD, MchOrth, and John J. Regan, MD. Video-Assisted Thoracoscopic Surgery for Thoracic Disc Disease. In Spine. April 15, Vol. 27. No. 8. Pp. 871-879.
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