Disc herniation is a condition in which the tissue (nucleus pulposuses) inside the cartilage that connects spinal bones (intervertebral discs) protrude and press on the surrounding nerves. It is believed that approximately 1% of the Japanese population has this condition, which is a typical cause of lower back pain. Anyone can get this condition and it affects people of a wide range of ages. Even a significant case is treated using conservative therapy and follow-up, because it resolves spontaneously in most cases. In a critical case, surgical intervention is required. Unfortunately, intervertebral discs lack regenerative ability, thus, the surgical incision will not close naturally, and as a result, the nucleus pulposus will project from a surgical wound in some cases. The recurrence rate of herniation is 5 to 10%.
Conventional surgical techniques imposed a heavy physical and psychological burden on the patients due to the massive scale, requiring them to remain bed-ridden in the hospital for several weeks. Our clinic specializes in percutaneous endoscopic discectomy (PED), which I first introduced to Japan in 2003. When employing this surgical technique, a surgeon removes the herniation through an incision of 6 to 8 mm on the back of the patient using minor forceps/radio waves/drill via an endoscope with an ultraminiature camera. Most patients are able to walk in two to three hours after surgery and leave the hospital on the following day. This brief surgical technique can be performed with local anesthesia as a day surgery. Some patients were socially rehabilitated two to three days after surgery. The relapse rate is as low as 3%, because of the small surgical incision.
To introduce PED to Japan, I jointly developed original equipment with a medical device manufacturer by offering opinions and undergoing the process of trial and error. I have researched orthopedic techniques, and disseminated and refined them for more than 30 years since I developed the diagnostic procedure for the inside of the vertebral canal using a fiberscope and established the endoscopic diagnostic procedure as a trainee doctor. All of these efforts aim to create an environment that reduces the burden on patients. The number of PED specialists is limited, although PED is in high demand among many corporate managers, people in show business and first-class athletes who want to avoid taking extended leave. The view provided by the ultraminiature endoscope camera is similar to a bug’s-eye view, showing the inside of the human body during PED.
As an operator, you should take a bird’s-eye view, that is, take a broad perspective and get a general visualization of the pathology based on images. You also need to have a sixth sense while fully sharpening the five senses when shaving the hard bone covering fragile nerves. It takes a long time to acquire such advanced skills. You cannot wait for years until you undergo a surgical operation for disc herniation that is accompanied by severe pain. However, it did become more difficult for patients to make an appointment for visits at the university hospital to which I belonged as awareness of PED increased. In 2014, I opened a clinic specializing in PED to treat the disease for eligible patients as soon as possible and train young doctors using my experience and skills. When I introduced dozens of PED devices from Europe and the U.S. in 2003, surgeons initially had a proactive attitude to the introduction but gave up learning how to use the devices, because of the high degree of difficulty of the surgery. I established this current technique while trying many different approaches without giving up. Nothing special is needed. What is important is persistence.
My lifelong work is training the operators and increasing indications of the technology to expand the use of PED. I am establishing a system for training young surgeons, having formed the Japan Spinal Endoscope Promotion Foundation. Currently, we aim to post a surgeon certified by the Japanese Orthopaedic Association in each prefecture. In addition, we will hold the international meeting on spinal endoscopy in Kobe in 2020. We are improving and making surgical equipment that aids and disseminates this technology. I developed percutaneous endoscopic laminotomy (PEL), which is the world’ least invasive surgery in which a thin drill is combined with the tube of the endoscope used for PED to shave off the bone pressing on the spinal canal. Now, indications for PED include herniated cervical disc, herniated thoracic disc and spinal canal stenosis.
If the needs of medical professionals are met by manufacturers through further collaboration between industry, academia and medical engineering, it will be possible to create a world of skilled Japanese craftsmanship. Such tasks and new challenges excite me. While the aging society is a universal issue, your skills can be refined, and your potential can become even greater after the age or 60 or 70. Personally, I plan to peak at the age of 75, and I am working on my health. Orthopedic conditions greatly influence Quality of Life (QOL) and Activities of Daily Living (ADL). Most are curable if a surgical operation is performed. I want more patients to recover using less invasive surgeries to be able to enjoy their lives in the long term.
