1. MYTH: The endoscopic method is untested for use in spine treatment.
That isn’t the way it is. The holmium endoscopic lumbar treatment was Food and Drug Administration (FDA) recognized for use in orthopedics and the spine in the early eighties and this endoscopic technique is approved by Medicare to treat spinal conditions on an out-patient basis. And, receiving this type of insurance authorization for a surgery is no minor feat!
Application of the endoscopic technique in spine treatment has produced lots of debate for numerous reasons. First, the laser unit is pricey, servicing is costly, and the endoscopic fibers are throw-away (and that means you have to use a fresh one each time), so price is a large consideration.
Secondly, many back doctors were never educated or trained to operate through a incision site of ½” or even smaller. The standard incisions are far more substantial and the individuals are under conventional sedation, so the positive aspects of the endoscopic technique may not seem that straightforward to someone not operating through a modest incision site. Yet, the value from operating in this way is irrefutable.
Dr Tony Mork puts it like this:
“If a procedure can be performed through a smaller incision (far more comfort to the individual and significantly less delicate tissue disruption) and get the same outcome as a more invasive approach measured a year out, I will take the tinier incision any day.”
The laser is a informative tool that may be quite effective, but it should be used effectively and for the right candidates, if the best outcomes are to be obtained. Up to now, Dr. Mork is not aware of any scientific publications that compare techniques, with and without the use of the laser, for the management of stenosis, facet syndrome or sacroiliac joint disorder. He uses the endoscopic approach in the treatment of all the disorders mentioned previously.
2. MYTH: The endoscopic approach is the only instrument for bony spinal stenosis.
The reality is that the endoscopic tool can be quite beneficial when carrying out some types of spine treatment, although it may not be the primary instrument to solve a dilemma. An important requirement to complete lumbar surgery correctly is good visualization, and this signifies that all hemorrhaging has to be managed.
The slighter the tube used (a lot more minimally obtrusive), the far more important the vision is. The significant benefit of using the laser in a modest tube is that it doesn’t use up very much space and it can deliver a extremely effective beam of power (heat). Soft areas and delicate bleeders behave nicely to the temperature from the laser, due to their water content. They simply shrink back or disappear (vaporize) whenever struck with the laser beam. The ray is very tiny and can be adequately directed at a particular focus, especially tiny bleeders, while not damaging nearby muscle tissues. This sort of precision is important in a limited space or when a modest incision site is used to do the surgery.
The main instruments that relieve boney stenosis are automatic bone slicing instruments. This is because bone doesn’t react that effectively to the high temperature from the laser and boney stenosis is generally fairly dense. It is Doctor Mork’s view that the ideal way to control the delicate muscle tissues and internal internal bleeding is to be able to see the zones that should be decompressed, particularly if employing a small tool. In many ways the endoscopic takes the place of electro-cautery, making it possible for the use of the littlest tool possible to do the surgery safely.
The smaller the approach (incision site) when performing treatment, the less pain and discomfort the patient will experience, less scar tissue formation formation will develop, less pain and discomfort drugs are essential, and faster recovery is indicated. By using this approach it is more likely it can be performed as an out-patient operation.
3. MYTH: The primary advantage of the laser is its curing powers.
This assertion is completely wrong. The chief advantage of the endoscopic approach is its warming characteristics! The laser is able to warm, vaporize and coagulate delicate tissues, like scar tissue formation, while operating in a very small region. The laser can practically get rid of the requirement for electro-cautery when doing spine surgery, that’s excellent because a lot of people are quite intolerant to electricity when surgery is conducted under twilight anesthesia.
Another perk rarely mentioned is how useful the warmth from the laser is in revision-type lumbar treatments, where there is quite a bit of scar tissue covered across the spinal nerves. The scarring around the nerves makes it hard to see them. When the laser is directed at the scar tissue formation from a small laser beam, it will warm formation and offer the person a sense of comfort in the leg or limb if a nerve is in the area. This is one more reason that Dr. Mork advocates conscious sedation with the endoscopic approach, especially when carrying out revision-type spine surgery, as the patient can assist him in avoiding injury and solving their dilemma.
4. MYTH: The laser works just as well on just about all disc herniations.
This isn’t accurate. After a disc piece develops within the area, the concern becomes “where will the disc piece go?” If the fragment remains in the disc limits, then a endoscopic approach may be handy. The endoscopic beam travels in a smooth line only and may be aimed directly at the disc fragment or may be used to produce a space adjacent to the piece for the fragment to drop back to.
A disc fragment may also travel from the limits of the disc to the back canal or lose complete connection with the disc and turn into a sequestered piece. At these times, most of the pieces will not be seen directly. If this cannot be noticed directly, it isn’t safe to use the laser, because the laser ray does not go around crevices.
A fragment that has shifted away from constraints of the disc may be in touch with a lumbar nerve, creating suffering in the leg region. These particles will often be large, and hard to view in their entirety. They should be pulled away from the lumbar nerves and selected with some sort of grasper; the endoscopic instrument on it’s own is not enough. Full removal of a good-sized extruded or sequestered disc fragment with the endoscopic tool alone would be very hard, if not not possible, from a technical and safety viewpoint.
5. MYTH: The most significant component to lumbar treatment is the use of the endoscopic instrument.
That’s doubtful, understand that the laser is a instrument, and how this tool is used is an essential part of the operation. Consequently knowledge about this instrument is essential. Medical doctor, Dr. Tony Mork has used the laser in a huge number of surgical treatments, almost all done using twilight sedation. He has researched many scholarly articles about the laser approach, but none discuss its rewards in modification-type spinal treatment, since not many folks have used it with conscious sedation.
Although the endoscopic approach represents a significant portion of the surgical procedures that he takes on, the most vital component to a prosperous spinal outcome is a accurate diagnosis, which is yet another topic for discussion. Use of the laser technique on it’s own will not be adequate; it requires expertise – and a lot of determination by the surgeon you ultimately choose.