Discoscopy vs. Foramenoscopy, one of the minimally invasive spine series
In the clinic, patients often ask: What is the difference between endoscopic discectomy (MED) and perforaminal endoscopic discectomy (PELD)? In fact, this is a rather technical question, and even many non-spine surgeons may not be able to understand it clearly, so it is difficult to explain in a few simple sentences. However, as the concept of minimally invasive surgery has become more popular, there is an urgent need for patients to understand these two procedures.
1. The emergence and development of MED and PELD
Endoscopic discectomy (MED) is a new technology invented in the 1990s. It combines traditional open discectomy technology with endoscopic technology. It is a minimally invasive and endoscopic version of traditional lumbar disc surgery. Its characteristics are that all surgical procedures are performed through a working channel with a diameter of 1.5 to 450px with the help of an endoscope. It relies on the imaging and magnification of the lens to obtain a clear image so that deep micro-lesions can be clearly seen on the monitor. Using special surgical instruments, the incision is small, the amount of tissue removed is small, the bleeding is small and the damage to normal tissue is small. The compression of the dura mater sac and the nerve roots can be directly observed and the operation can be performed under direct vision. Nerve root decompression is precise and thorough, and can reduce the occurrence of complications such as neurovascular damage, while achieving satisfactory and reliable therapeutic effects. It is suitable for most types of lumbar disc herniation (you need to consult your doctor to know which type of herniation is suitable for endoscopic disc surgery).
Perforaminal endoscopic lumbar discectomy (PELD) was actually first invented by Professor Anthony Yeung in the United States in the 1990s, but this technology was not widely promoted at the time due to some of its own limitations. Subsequently, Professor Thomas Hoog Land of Germany developed the Thessys technology based on Yeung's technology, which has been widely recognised by spine surgeons and is currently the most commonly used perforaminal endoscopic lumbar discectomy. In addition to the ability to clearly visualise deep microlesions on the monitor, as with the intervertebral disc technology, so that precise surgical operations can be performed, the main feature of this technology is that it is less traumatic (the incision is half that of the MED), so it is more minimally invasive and has now become a pioneering technology in the field of minimally invasive spinal surgery. So what are the differences between endoscopic discectomy (MED) and perforaminal endoscopic lumbar discectomy (PELD)?
2. Differences between MED and PELD
Firstly, both technologies are icons in minimally invasive spine surgery. Both technologies use endoscopes to clearly visualise deep microlesions on the monitor, enabling precise surgical procedures and good treatment outcomes. However, there are some differences between the two technologies, which are outlined below:
1. Incision size is different
Although both are minimally invasive, the incision for the discoscope technique is approximately 37.5px, while the incision for the foraminal endoscopic technique is generally half this size, approximately 17.5px. The foraminal endoscopic technique is more minimally invasive than the discoscopic technique;
2. Different anaesthetic methods
The discoscopic technique uses general anaesthesia (some centres use spinal anaesthesia) and the patient does not feel any pain during the operation and feels as if the operation has been done after a "night's sleep". In the foraminal endoscopic disc technique, local anaesthesia is used and the patient can feel the whole operation, sometimes a little uncomfortable and sometimes quite painful (especially when grinding the articular process before placing the channel). Therefore, in terms of the experience of the operation, the patient does not feel any pain during endoscopic disc surgery and the experience seems to be better;
3. Different surgical approaches
Endoscopic disc surgery is performed from the posterior approach, which is similar to the traditional open surgery approach. Therefore, endoscopic disc surgery may be easier for doctors to master. However, foraminal endoscopic surgery is performed from the lateral and posterior aspects, which is completely different from the approach of traditional open surgery. Therefore, this type of surgery is more technically challenging for doctors. Of course, with the advancement of technology, foraminal endoscopic technology has also been developed for the "interlaminar approach" from the posterior approach.
4. Indications and therapeutic benefits
The indications for surgery are a little too professional and difficult to explain all at once. But you can understand that young people and fresh lesions are relatively more suitable for minimally invasive surgery. Whether endoscopic disc surgery or foraminal endoscopic disc surgery is used depends on the specific situation. For example, extreme lateral lumbar disc herniation is more suitable for foraminal endoscopic disc surgery, whereas axillary disc herniation is easier to treat with endoscopic disc technology.
Recently, a VISTA system has been developed in discoscopic technology that can perform fusion surgery. With this technology, some operations that previously required major surgery, "steel nailing" and "fusion" can now be performed under discoscopy. This avoids "major surgery" and achieves the goal of minimally invasive treatment, which represents the highest level in the field of minimally invasive spine surgery.
In terms of treatment effects, both discoscopic technology and perforaminal endoscopic technology can achieve relatively ideal treatment effects, and there is not much difference between the two.
5. Post-operative recovery
Theoretically, patients can get up and move around a few hours after PELD surgery, but in clinical practice patients are often required to get up and move around the next day. As MED surgery is performed under general anaesthetic, patients will need to stay in bed for a period of time after surgery to ensure that they are fully awake from the anaesthetic. However, a few hours is usually enough and patients can get up and move around the next day. This means that recovery from both procedures is very quick, which is much better than traditional open surgery. If you have to compare which one recovers faster, PELD surgery recovers faster because the incision is smaller and it is a local anaesthetic.
6. Recurrence rate
This is another question that everyone is concerned about. In fact, these two technologies, like traditional open surgery (simple excision), have a certain probability of recurrence, which is about 4%-8%. But it is really difficult to say which will recur and which will not in a particular patient. The general principle is related to age, personal constitution, specific condition, etc.
In short, MED and PELD are two iconic technologies in the field of minimally invasive spine surgery, each with its own characteristics and advantages. For specific treatments, doctors will choose the most appropriate surgical method based on the patient's specific situation.
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