Transforaminal Selective Endoscopic Discectomy: highly minimally invasive surgical medicine for lower back and leg pain.
While 95% of population who retain an injury to their lower back will recover with a mixture of conservative medicine and preventative measures there is a small group of patients who fail to sass to these measures.
This description is meant for those patients who remain unhappy with their symptoms and have been advised by their treating physicians that they would have to live with their present symptomatology or feel broad spinal surgery. The following data is about Selective Endoscopic Discectomy an alternative course for those patients who do not want to live with lasting pain, feel broad spinal surgery and do not want to have general anesthesia.
The typical patient frequently presents several months or more after having sustained an injury to the lower back with no old history of any back problems. First medicine from the general practitioner, chiropractor or emergency room physician might consist of that the patient take anti-inflammatory medication, analgesics, muscle relaxants, limit activities and receive physiotherapy. When the patient's problem did not resolve the patient may have been sent to an orthopedic or neurosurgical devotee who scheduled the patient for an Mri scan that may have revealed one or many disc bulges, disc protrusions or disc herniations. The patient may have been provided with supplementary medicine in the form of a lower back brace and a series of epidural cortisone injections along with specific trunk/abdominal/lower back stabilization exercises or Pilates exercises. While the patient may have noticed some partial revising with any or all of the above measures he or she may have primary residual lower back pain and radicular pain into one or both of the legs. At that point the patient may have been told that surgical intervention would be primary in the form of either a micro lumbar laminectomy or a Metrx discectomy under general anesthesia or if the problem was more broad that a spinal fusion or disc replacement surgery might be indicated.
At that point after accepted describe of the patient's history and performing a complete bodily exam and discussing the patient's Mri scan I might find that the patient could be a candidate for the Selective Endoscopic Discectomy course if the patient was found to have either a contained lumbar disc protrusion or lumbar disc herniation unassociated with elements of severe arthritic changes. At that point we would suggest to the patient that supplementary confirmatory testing be performed in the form of a appealing discogram to resolve the exact disc that is causing the residual pain and then effect the discogram with a Selective Endoscopic Discectomy procedure.
A discogram is an X-ray study performed under flouroscopic control in an patient surgical center using local anesthesia. A needle is settled in the center of the abnormal disk and in an adjoining general disc and a clarification consisting of X-ray contrast dye mixed with indigo Carmine blue dye is injected into these discs. Since the patient is awake as the dye causes expanding pressure in the center of the disc most likely this will reproduce the patient symptoms in the back and/or leg pain and also define the abnormal anatomy of the damage disc on the floroscope. If the patient's symptoms are reproduced by this discogram it is thought about a clear concordant discogram and the patient can then be treated with the Selective Endoscopic Discectomy either immediately or at a later time if assurance authorization is required.
The Selective Endoscopic Discectomy course is then performed under local anesthesia with the patient awake and in the prone position on extra pillows. A small needle is inserted into the disc space after local anesthesia has been administered. A 7mm (1/4inch) skin incision is made and a spine arthroscope is slipped into the abnormal disc. Under fluoroscopic control, the micro-instruments (mini forceps, mini curettes, and mini cutters-shavers) and the laser probe are used for removal of only the damaged disc material. The laser is used for supplementary removal and shrinkage of the disc for the purpose of disc decompression and tightening up of the annulus. The course takes about 30 minutes to an hour per disc, on the average. The estimate of disc removed and shrinkage by the laser varies, but includes only the herniated and damaged portion. The supporting structure of the disc is not affected. Upon completion, the probe is removed and a small Band-Aid is applied over the needle incision. Since the patient is awake during the course frequently they are concerned in watching the monitor as we take off the damage disc material.
After surgery the patient is sent home and advised to use ice packs on the lower back and take mild oral analgesics and rest for few days. Many patients are able to resume work within a few days. The patient are advised prior to the course that if the preoperative pain was primarily lower back that in excess of 86% good and excellent results should be expected. If the patient's pain was back and leg pain good and excellent results should coming 92%.
Most of the time the patient's return to the office one week later feeling much improved and wanting to know why this course was not performed on them earlier and why the course works. We believe that this technique is prosperous because the abnormal portion of the disc that is creating internal pressure against the annulus and nerve root is removed, the fissures in the annulus that allow leakage of disc fluid and material are sealed and tighten up and the constant flow of irrigating saline through the endoscope washes out the irritating damaged metabolites( prostaglandins, histamines,and substance P & X). No deep tissue is cut and commonly no bone has to be removed.
The following patients are not candidates for selective endoscopic discectomy:
1. The rare patient than has a disk that has come to be a fully extruded and migrated up into the spinal canal.
2. The patient has broad spinal stenosis will need an broad estimate of bone removed which is best done with open surgery.
3. The patient has broad spinal instability and requires a spinal fusion that must be done with an open procedure.
For those patients who are afraid of having broad spinal surgery and have been told that they will have to live with their lower back pain, Selective Endoscopic Discectomy is an appealing prosperous minimally invasive surgical alternative course that it is performed under local anesthesia and has a very high rate of patient satisfaction. For supplementary data see www.back-surgery-online.com.
Endoscopic Surgery:Selective Endoscopic Discectomy: extremely Minimally Invasive surgical operation