- What is SED
- About The Procedure
- Advantage Of SED
- Potential Complications
- Who Required This Procedure ?
- Postoperative Instructions
- Instruments
Selective Endoscopic Discectomy (SED) is a minimally invasive spine procedure technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. Muscle and tissue are dilated rather than being cut when accessing the disc.
- Selective Endoscopic discectomy procedure time is approximately 60 – 90 minutes per disc.
- Sedation and local anaesthesia is provided.
- Entry point is precisely calculated by x-ray guidance measurements
- A small 8 to 10 mm incision is made on the back to the side of the spine.
- First long needle is introduced inside the targeted disc. Position of needle is very much important step in success of endoscopy.
- Through needle guide wire is place inside the disc and needle is removed.
- A conical probe (dilator) is used to dilate a path to the disc. No need to cut any muscles.
- A cannula being passed over the blunt dilator followed by insertion of the endoscope and operating instruments.
- Degenerated nucleus pulposus is visualized on TV monitor and selectively removed from the herniated disc.
- A 4.0 Mh Radio frequency (Germany) electrode is used to help control bleeding, shrink the disc tissue or shrink the annulus.
- If patient had bony osteophytes then we can break with Nouvag burr (Germany).
- Nerve root which is compressed by herniated disc now seen free moving is the end point of endoscopic discectomy.
- Less postoperative pain,
- Less body tissue damage
- Quicker recovery times,
- Earlier rehabilitation,
- Avoidance of general anaesthesia
- Less side effect than open spine surgery
- Less chance of Neurological damage (Paralysis)
Although complications are rare, they can occur. Complications are similar to traditional surgery, which may include death and paralysis. Infection, Nerve injury, Dysesthesia, complex regional pain syndrome, dural tears, bowel injury, psoas hematoma, epidural hematoma, and segmental instability are complications that may occur and may require additional treatment or surgery to resolve.
This is a new advanced procedure, non-endoscopic spine surgeons and endoscopic surgeons not familiar with this technique may give you a different opinion that is based on their own experience or with their familiarity with the literature.
You may be a candidate for the procedure if you
- Have leg pain, numbness, tingling made worse by sitting or bending your back
- Are not any better after 4 – 6 weeks of conservative treatment including rest and physical therapy
- Are not better after epidural blocks
- Have an MRI showing a disc herniation
Pain Control
Patient may have mild discomfort in the surgical area. Oral analgesics, muscle relaxants, and non-steroidal anti-inflammatory medications may be used as prescribed by your physician.
Hospital Stay
one or two days
Postoperative Care
- Moderate activities with rest periods as needed.
- No sexual relations until you are well on your way to recovery.
- No bending, or twisting of back, avoid sitting or standing more than 30 min at a time without break
- Do not lifting of more than 3 to 7 Kg after 1 week; no lifting over 10 Kg for 6 weeks.
- You may return to work within 1 to 4 weeks after procedure or as able.
- You may resume driving 1 -2 weeks after procedure or sooner
Activities
-
Walking :
- Week 1: 10 minutes – 3 times/day
- Week 2: 15 minutes – 3 times/day
- Week 3: 20 minutes – 3 times/day
-
Exercise :
- Hamstrings stretching exercise done regularly for 4 week with some back muscle strengthening exercise
- After 4 week lumber and abdominal muscle strengthening exercise can be started according to Mackenzie guideline. This exercise is useful to strengthen muscle and reduce load on spine and disc
