Disc Herniation and Spinal Stenosis

In this video Dr. Tony Mork describes a way to treat the combination painful stenosis with a disc herniation endoscopically with the Laser.
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Hi, I’m Dr. Tony Mork endoscopic spine specialist. Today I’d like to talk about a situation that I see fairly often in the office particularly in people who are maybe older than 70 years of age, and of course as an endoscopic spine surgeon I think we’re all trying to do the least amount of surgery possible but what do you do when you’re faced with a disc herniation or protrusion of considerable size as well as stenosis.

The typical response is I think most of us would like to do one thing or the other. I’m going to show you when I did one thing and really probably should have done both at the same time. In this case I have an 81 year old very active woman who showed up with a progressive leg pain in spite a conservative therapy and a few epidurals.

So let me show you her MRI scan and you be the judge about how you would start this case. As you can see there’s a large protruding disc at the L3-4 for level, which certainly would account for her symptoms, as well as we’ve got some overgrowth of the soft tissues in the spinal canal post eerily. If we look at the latter we can certainly see a broad-based protruding disc, as well as some very thickened ligamentum flavum and some overgrowth and hypertrophy of the facet joints. As I go through this we can see that there’s also some fairly good-sized disc protrusion there and it is biased to the left hand side.

Even trying to avoid doing some additional surgery with some persistent symptoms showing up after the discectomy, I felt that a this may have been better treated with both a trans-foraminal discectomy as well as a small laminal for foraminal-plasti, using a metric set.  I hope today that I’ve shown you the benefits of doing two approaches to two different problems on the spine using the absolute minimum of surgery using a trans-foraminal discectomy as well as a small lemon foraminal-plasti for a combination treatment for a disc herniation and stenosis.