Endoscopic Spine Surgery, Is The Ultimate Minimally Invasive Surgical Approach
I am Dr Tony Mork and I specialize in Endoscopic Spinal Surgery without a fusion. I refuse to fuse when possible.
There are only a few things in the world where “Less is Better”, but Spine Surgery has got to be one of them. The ultimate in “minimally invasive surgery” is Endoscopic Spine Surgery (without a fusion). The term “minimally invasive” is really meaningless. The term doesn’t tell you the size of the tube that surgery is being performed thorough (usually 18-22mm) and now fusions are being performed with “minimally invasive” techniques. I would hardly describe a fusion as a minimally invasive procedure!
Endoscopic spine surgery is performed through a 7-10mm tube, in a water environment (no air) without a fusion.
The goal is to relieve your pain and give you back your life with the minimum of everything else. This means minimal incision size, minimal disturbance to soft tissues, minimal scar formation, minimal blood loss and complications, minimal anesthesia and recovery time, and outpatient surgery. It also means, No Fusion.
Endoscopic Spine Surgery treats a wide variety of painful conditions in the spine that can be degenerative or acute in nature. These conditions can occur in the cervical, thoracic, or lumbar spine. My estimate is that 70-80% of fusions could be avoided if endoscopic spine surgery was done first.
What surgical procedures can be performed on the spine?
For all the complicated terms and language surrounding spine surgery, there are only 4 operations.
- Decompression (removal of whatever is causing pressure on a nerve)
- Disc Replacement
- Rhizotomy (division of pain producing sensory nerves)
Endoscopic spine surgery works great for majority of painful spine conditions. Typical conditions that can be treated are stenosis, foraminal stenosis, disc herniations or protrusions, facet syndrome, annular tears and sometimes “failed back surgery”.
The goal of surgery is to relieve pressure or irritation of the affected nerve root(s) or to interrupt the sensation of pain from painful sensory nerves.
Patient selection and diagnosis are the first and most important first steps to success. These also determine if someone is a candidate. There are certain conditions that need to be treated with larger surgery and a fusion, so the first thing that must be determined is whether you are a candidate.
It’s best to have your symptoms of pain, numbness or weakness match the findings on the MRI scan, which can be likened to an “electrical wiring diagram”. If your pain is not “classical”, another approach (pain mapping) can be taken to determine the cause of the pain.
Why should I avoid a fusion if possible?
There is well-documented long-term evidence that the discs above and/or below the fusion will degenerate prematurely. This problem (adjacent disc disease) will occur about 50% of the time in the lumbar spine and 25% of the time in the cervical spine after 10 years and continues on from there. The adjacent disc disease is caused by the additional wear and tear occurring in the remaining discs that aren’t fused. Adjacent disc disease can result in the need for additional fusion surgery. Refuse to fuse when possible.
What if there is confusion about the cause of pain?
Sometimes there are a few possible causes of pain. In this situation, some “diagnostics” or “spinal pain mapping” can be performed to help make the correct diagnosis, which is essential to a great outcome. The more accurate the diagnosis, the more minimal the surgery. Endoscopic spinal surgery is not exploratory.
In most cases, pain pills don’t really take the pain away and require increasing doses to be effective. If your pain interferes with sleep and the activities of daily living and is no longer responsive to manipulations, physical therapy, or epidurals, then surgical treatment of the spine may be the only way to relieve the pain, weakness, or tingling. In desperation to get some relief, you take a trip to the surgeon, and he might tell you that you need a fusion with a plate, screws and a bone graft!
Since my early days in practice, I have always wanted people to retain as much range of motion as possible since the body is meant to move. If surgery is necessary then it should be performed through the smallest possible incision with the minimal disturbance of soft tissues And allow the natural motion to continue when possible. I think it’s also wise to operate directly on a problem, when possible, rather than restructure the surrounding anatomy, which is done with a fusion. I always struggled with the concept of creating “one problem” to solve another.
Why is it a good idea to start with an Endoscopic procedure?
If you have a problem that can be solved with a small procedure, wouldn’t that be the procedure of choice? Of course, you have to examine all the facts and decide for yourself, but if I could avoid a fusion with a small endoscopic procedure, I would. If the small endoscopic procedure was not satisfactory, then a fusion is an option, but it doesn’t work the other way around.
Why doesn’t everyone do endoscopic spine surgery?
There are several reasons:
- The learning curve is steep.
- The techniques have only recently been taught in a few fellowships.
- The German equipment is expensive.
- Three dimensional skills need to be exceptional.
- Not enough arthroscopy experience.
The pain interferes with sleep and the activities of daily living as well as recreational activities. Some people require the use of pain pills, which they don’t want to take. And then in desperation to get some relief, you take a trip to the surgeon, and he tells you that you need a fusion with a plate, screws and a bone graft!
Sometimes you will hear that if you don’t get it operated on immediately, that you run a significant risk of paralysis!
Since my early days in practice, I have always wanted people to retain as much range of motion as possible; I mean the body is meant to move.
If surgery is necessary then it should be performed through the smallest possible incision with the minimal disturbance of soft tissues And allow the natural motion to continue when possible. I think it’s also wise to operate directly on a problem, when possible, rather than restructure the surrounding anatomy, which is done with a fusion. I always struggled with the concept of creating “one problem” to solve another.
For more information or to see if you are a candidate, call us now for a free one-on-one consultation with Dr. Mork.