Minimally invasive tubular microdiscectomy - A 3-D operative video

Minimally invasive spine techniques have been developed with the goal of achieving the same outcomes of open surgery through smaller incisions and minimal muscle dissection. Paraspinal muscle dissection and devascularization is a cause of postoperative pain, wound infection, and prolonged hospitalization. It has been well documented that with minimally invasive tubular access surgery, muscle stripping is obviated, resulting in faster patient recovery, and decreased complication rates (CSF leaks and wound infections) while maintaining similar long-term outcomes compared to open techniques.In this video, we describe a common application of tubular surgery: minimally invasive discectomy, demonstrated in a 3-dimensional video. A 47 year old female whose BMI was 45.7 presented with right lower extremity radiculopathy with radiating pain along the L5 dermatome. She also had weakness with dorsiflexion. She was evaluated with an MRI that showed a large right-sided paracentral disk herniation at the L4/5 level. Her symptoms progressed in spite of three months of conservative treatment. Therefore, she underwent a right-sided minimally invasive discectomy where a large disk fragment was resected. The patient had immediate relief of her symptoms and was discharged home the same operative day.This operative video also serves as an educational tool for residents interested in minimally-invasive spine surgery, where personal exposure with the technique is limited until they reach their more senior operative years.