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 performed with laser assist. 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)
Rhizotomy (division of pain producing sensory nerves)
Minimally Invasive surgery works great for decompression and rhizotomy procedures. 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 is the first and most important first step to success. It’s so important 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”. Sometimes the pain is not “classical” so another approach can be taken to determine the cause of the pain.
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 minimal the surgery, the more important it is to make the correct diagnosis. This type of minimal surgery is not exploratory.
Why doesn’t everyone do minimally invasive surgery?
It is difficult to learn and the learning curve is steep. Only recently have a couple of Universities started to teach this technique. The best equipment comes from Germany and it is expensive to have all the necessary trays.
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 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. For more information or to see if you are a candidate, call us.