A new milestone in spine care: Spine endoscopy experience at kauvery hospital, Trichy (Cantonment) – 2025

Jarina1, Subathra Devi. M2, Maha Lakshmi3*

1Operation Theatre In-charge, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

Endoscopic spine discectomy is a minimally invasive surgical technique used for the treatment of symptomatic intervertebral disc herniation. This procedure utilizes advanced endoscopic visualization and specialized instruments to remove herniated disc material while preserving normal spinal structures. Compared to conventional open surgery, endoscopic discectomy offers several advantages including reduced tissue damage, minimal blood loss, shorter hospital stays, and faster recovery. It can be performed under local or general anesthesia, making it suitable for selected high-risk and elderly patients. With improved surgical precision and better functional outcomes, endoscopic spine discectomy has become an effective and patient-friendly alternative in modern spine surgery.

Key words: Endoscopic spine discectomy; Lumbar disc herniation; Cervical disc herniations.

Introduction

Lumbar disc herniation is a common cause of low back pain and sciatica, often affecting the working-age population. While conservative management remains the first-line treatment, surgery is indicated in patients with persistent pain, neurological deficit, or failed non-operative therapy. Endoscopic spine discectomy has emerged as an effective alternative to conventional discectomy, offering comparable clinical outcomes with reduced morbidity.

Intervertebral disc herniation is one of the most common causes of back pain and radiculopathy, significantly affecting patient mobility and quality of life. Traditionally, open discectomy and microdiscectomy are considered standard surgical treatments for patients who do not respond to conservative management. However, these procedures involve muscle dissection and bone removal, which may lead to postoperative pain, longer recovery time, and potential spinal instability.

Advancements in minimally invasive spine surgery have led to the development of endoscopic spine discectomy. This technique uses a small skin incision and muscle-splitting approach, allowing direct visualization of the herniated disc through an endoscope. The procedure minimizes tissue trauma and promotes faster rehabilitation while maintaining spinal stability. Due to these benefits, endoscopic discectomy is increasingly being adopted worldwide as a safe and effective treatment option for selected lumbar and cervical disc herniations.

Indications

  • Single-level lumbar disc herniation.
  • Persistent radicular pain despite adequate conservative treatment (6–8 weeks).
  • Neurological deficit correlates with imaging findings.
  • Recurrent disc herniation in selected cases.

Advantages of Spine Endoscopic Discectomy

Surgical advantages

  • Minimally invasive — very small skin incision (5–8 mm).
  • Less muscle damage — muscle splitting rather than cutting.
  • Minimal bone removal.
  • Better visualization with endoscopic magnification and illumination.
  • Targeted disc removal with less disturbance to normal structures.
  • Visualization of blind areas is possible because of angled scope (20 deg).

 

Patient benefits

  • Less postoperative pain.
  • Reduced blood loss.
  • Lower infection risk.
  • Minimal scar formation.
  • Shorter hospital stays (often same-day or next-day discharge).
  • Faster recovery and early mobilization.
  • Quicker return to work and daily activities.

Anesthesia & recovery

  • Useful for high-risk or elderly patients.
  • Continuous patient feedback possible during surgery (in selected cases).

Functional outcomes

  • Preserves spinal stability.
  • Lower risk of epidural fibrosis.
  • Lower chance of postoperative instability.
  • Good outcomes in contained and foraminal disc herniations.

Hospital / OT perspective

  • Shorter OT time in experienced hands.
  • Reduced need for ICU stays.
  • Faster bed turnover.
  • Lower overall treatment cost in many cases.

Role of Operation Theatre tpam

Preoperative phase

  • Preparation of patient: Verify identity, consent, allergies, fasting status.
  • Psychological support: Reduce anxiety, explain procedures.
  • Physical preparation: Skin preparation, IV-line insertion, removal of jewelry, dentures, nail polish.
  • Safety checks: Surgical site marking, checklist completion.
  • Equipment readiness: Sterile instruments, anesthesia machine, monitoring devices.

Intraoperative phase

  • Scrub nurse role: Maintain sterile field, assist surgeon, instrument counts.
  • Circulating nurse role: Position patient safety, monitoring environment, document events.
  • Patient safety: Prevent pressure sores, nerve injuries, burns from cautery.
  • Communication: Coordinate between surgical team and external staff.

Postoperative phase

  • Recovery room care: Monitor consciousness, airway, vitals.
  • Pain management: Assess pain, administer prescribed analgesics.
  • Wound care: Observe dressing, drains, bleeding.
  • Documentation: Record intra- and postoperative events.
  • Patient education: Instructions for mobility, diet, wound care.

Anesthesia considerations

  • It can be performed under local anesthesia with conscious sedation or general anesthesia.
  • Continuous neurological monitoring during local anesthesia cases.
  • Adequate patient positioning and pressure point care.
  • Intraoperative pain control and hemodynamic monitoring.
  • Postoperative pain management and early mobilization.

Instruments and equipment

  • Endoscopic spine system (working cannula, obturator, endoscope).
  • High-definition camera and monitor.
  • Radiofrequency probe.
  • Endoscopic forceps and dissectors.
  • Irrigation pump.
  • C-arm fluoroscopy.

Surgical steps

  • Level localization under fluoroscopy.
  • Skin marking and local infiltration.
  • Small skin incision (5–8 mm).
  • Sequential dilation and placement of working cannula.
  • Introduction of endoscopes and identification of anatomical landmarks.
  • Removal of herniated disc fragments under direct visualization.
  • Hemostasis using radiofrequency probe.

Decompression confirmation and wound closure

Surgery Outcomes of Endoscopic Discectomy

Outcomes and Follow-up

Patients typically experience rapid pain relief and early mobilization. Most are discharged within 24–48 hours. Regular follow-up is essential to assess neurological recovery and recurrence.

Conclusion

Endoscopic spine discectomy is a safe and effective minimally invasive surgical procedure for the management of selected intervertebral disc herniations. The technique offers several advantages over conventional open surgery, including minimal tissue damage, reduced blood loss, less postoperative pain, shorter hospital stays, and faster recovery. It also helps in preserving spinal stability and reducing postoperative complications. With advanced visualization and targeted disc removal, this procedure improves patient outcomes and quality of life. Proper patient selection, skilled surgical technique, and coordinated perioperative nursing care play a vital role in achieving successful surgical results. As minimally invasive spine surgery continues to advance, endoscopic discectomy is becoming an important and preferred treatment option in modern spine care.

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