What is Endoscopic Lumbar Discectomy (Transforaminal Endoscopic Lumbar Discectomy - TELD)?
Endoscopic lumbar discectomy or transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive surgical procedure used to treat herniated discs in the lumbar spine.
TELD involves accessing the affected disc through the intervertebral foramen, which is the opening between adjacent vertebrae through which nerve roots exit the spinal canal. This approach allows for targeted treatment of the herniated disc while minimizing disruption to surrounding tissues. TELD is considered minimally invasive because it involves making a small incision and using specialized tools and an endoscope (a thin, flexible tube with a camera) to access and treat the affected disc.
Lumbar Spine Anatomy
The spine, also called the backbone, plays a vital role in stability, smooth movement, and protection of the delicate spinal cord. It is made up of bony segments called vertebrae with fibrous tissue called intervertebral discs between them. The vertebra and discs form the spinal column from the head to the pelvis, giving symmetry and support to the body. The spine can be divided into 4 parts: cervical, thoracic, lumbar (lower back), and sacral region. The lumbar spine is composed of the lower 5 vertebrae, numbered L1–L5.
Indications for Endoscopic Lumbar Discectomy (Transforaminal Endoscopic Lumbar Discectomy - TELD)
Endoscopic lumbar discectomy or TELD is typically considered for patients who have not responded to conservative treatments such as medication, physical therapy, or epidural injections for their lumbar disc herniation.
A herniated disc is a condition in which the outer fibers (annulus) of the intervertebral disc are damaged, causing the soft inner material of the nucleus pulposus to rupture out of its space. A herniated disc, common in the lower back (lumbar spine) occurs when there is a tear in the outer lining of the disc (annulus fibrosus). This causes the inner jelly-like material (nucleus pulposus) to leak out and place pressure on the adjacent spinal nerve root. It is the most common cause of lower back pain and pain that radiates down the leg (radiculopathy).
Preparation for Endoscopic Lumbar Discectomy (Transforaminal Endoscopic Lumbar Discectomy - TELD)
Before the surgery, your healthcare provider will conduct a thorough medical evaluation, including a review of your medical history, current medications, supplements, and allergies. Imaging studies such as X-rays, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans may be performed to assess the anatomy and condition of the lumbar spine or herniated disc and guide the surgical planning. Your surgeon may instruct you to avoid certain medications and supplements that can thin the blood and increase the risk of bleeding during surgery. You should not consume solids or liquids at least 8 hours prior to surgery. A signed informed consent form will be obtained from you after the risks and benefits of the surgery have been explained.
Procedure for Endoscopic Lumbar Discectomy (Transforaminal Endoscopic Lumbar Discectomy - TELD)
In general, the procedure for endoscopic lumbar discectomy or TELD may involve the following steps:
- The patient is positioned on their stomach under local or general anesthesia. The procedure is typically guided by fluoroscopy (real-time X-ray imaging).
- A small incision, typically less than 1 centimeter, is made on the back near the affected disc.
- A narrow tube called an endoscope is inserted through the incision and guided to the area of the herniated disc.
- The endoscope has a camera and light source that allows the surgeon to see inside the spine without the need for a large incision. This provides a clear view of the disc and surrounding structures.
- Specialized tools are passed through the endoscope to access the herniated disc.
- The surgeon then removes the herniated or damaged portion of the disc using specialized instruments through the endoscope. This helps relieve pressure on nearby nerves and reduces symptoms such as back pain, leg pain, and numbness caused by the herniated disc pressing on spinal nerves.
- Once the procedure is complete, the incision is closed with sutures or adhesive strips.
Postoperative Care and Recovery
After surgery, you will be taken to the recovery room where medical staff will monitor your vital signs and ensure you wake up safely from anesthesia. After waking up, you will receive instructions on postoperative care, including pain management, activity restrictions, exercises, mobility guidelines, and wound care. This is an outpatient procedure and all patients are discharged on the same day from either the hospital or surgery center. Follow-up appointments will be scheduled to monitor your healing progress and adjust your rehabilitation plan as needed to optimize recovery and long-term outcomes.
Risks and Complications
Endoscopic lumbar discectomy or TELD is considered a relatively safe procedure. However, as with any procedure, some risks and complications may occur such as infection, bleeding, nerve injury, blood clots, anesthesia risks, and rupture of the dura mater (a protective layer surrounding the spinal cord and nerves) which can lead to cerebrospinal fluid leakage.
Benefits
Endoscopic lumbar discectomy or TELD offers several advantages over traditional open surgery for lumbar disc herniation. These include smaller incisions, less trauma to muscles and other tissues, reduced blood loss, shorter hospital stays, faster recovery times, and potentially lower rates of complications.