Endoscopy

The full promise of minimally invasive spinal surgery (MISS) for herniated disc and spinal stenosis has now been realized. Foothills Regional Pain Center is pleased to announce the availability of endoscopic microdiscectomy for many spinal problems causing back pain and sciatica previously requiring treatment by open spinal surgery and spinal fusion operations. Endoscopic microdiscectomy allows spinal pain specialists to treat these problems with less tissue trauma and preservation of spinal motion, allowing faster recovery time and earlier return to normal activities.

Using microinstruments and high resolution video endoscopy, painful disc herniations, bone spurs, and spinal arthritis compressing sensitive nerve tissues can be alleviated through a “keyhole” incision in the side without general anesthesia, stripping of muscle, or weakening of the spine.

First, under local anesthesia a needle is guided into the spinal canal through the natural opening in the side of the spine, called the neuroforamen (Illustration 1).

Next, endoscopic instruments are placed into the area of the herniated disc through the neuroforamen. Once inside, special tools are used to expand this natural opening to allow adequate access to the disc and spinal nerves (Illustration 2).

A high resolution video endoscope, or television camera and specially designed endoscopic instruments are placed through a small tube into the spinal canal where the herniated disc, nerves, and related structures can be clearly seen and protected. The offending disc herniation or bone spur is identified and removed, eliminating pressure and pain caused by nerve root compression (Illustration 3).

Following nerve root decompression, pulses of radiofrequency (RF) energy are applied to the disc covering to help seal and close the defect left by removal of the herniated disc fragment to help prevent future herniations (Illustration 4).

Finally, laser energy is applied to the inside of the disc to further shrink and tighten the soft jelly-like disc center or nucleus (Illustration 5).

At the completion of the procedure the instruments are removed, and a single stitch or bandaid dressing is applied and the patient is discharged home. The entire procedure can usually be completed within 90 minutes or less. Post procedure care usually involves physiotherapy and graded exercise, allowing return to sedentary work within 7 to 10 days following the procedure. Patients with more physically demanding occupations are usually allowed to return to work within 2 to 3 weeks.

Endoscopy:

Endoscopic microdiscectomy has been widely acclaimed and used worldwide in the United States, Europe, and elsewhere as a replacement for traditional back and neck surgery for the majority of patients with typical spinal pain conditions. The procedure is recognized and approved by Medicare and many insurance plans. Call Foothills Regional Pain Center to arrange a consultation to determine if you may benefit from this exciting new procedure for the treatment of spinal pain and sciatica.

Endoscopic microdiscectomy -vs- Laser disc decompression:

Two excellent treatment choices are now available at Foothills Regional Pain Center for the treatment of painful discs and spinal pain problems resulting from pinched nerves. Small, contained disc herniations less than 5 mm in size, tears in the disc, painful disc degeneration without herniation, and early onset spinal stenosis symptoms caused by disc bulging may be treated successfully with laser disc decompression alone, simply by placing a laser needle and fiber alone. Larger disc herniations greater than 5 mm in size, trapped or displaced fragments, collapsed or severely degenerated discs, or painful bone spurs and bone cysts will usually require the endoscopic approach and the use of combined endoscopic techniques outlined above. The availability of both techniques has greatly expanded the ability of interventional pain specialists to treat the majority of patients with disc herniations, disc degeneration, failed prior back surgery, pinched spinal nerves, and spinal stenosis without major open spinal surgery, spinal fusion, or spinal implants. Consultation and clinical examination by specialists at Foothills Regional Pain Center will help to determine which type of minimally invasive spinal intervention is right for you.

Out of town patients:

Out of town patients may request review of MRI films and telephone consultation to determine if they are candidates for endoscopic microdiscectomy. One of our clinical specialists will discuss your symptoms and MRI film results, and provide written documentation of the findings and recommendations to you or your referring health care provider. If you are not felt to be a candidate for the procedure, travel to our Seneca facility will not be required. If you are a candidate, local accommodations and a full clinical examination will be arranged prior to the performance of the procedure. Further details and instruction for off site evaluation and consultation may be obtained by contacting the Foothills office.