Endoscopic spinal surgery Q&A
Q: What is endoscopic spinal surgery? Why haven’t I heard more about it?
A: At Synergy Spine Center we offer full endoscopic spinal surgery for the treatment of herniated discs and spinal stenosis that have not responded to conservative treatment. Not all spinal procedures claiming to be “endoscopic” are the same. Full endoscopic spinal surgery is performed through small tubes no larger than a pencil and is the modern alternative to traditional open spinal surgery or microdiscectomy. Full endoscopic spinal surgery is relatively new, and has been developed and perfected in the U.S., Europe, and Asia over the last 10-15 years. It is an attractive treatment option for many patients because of its reduced cost, safety and effectiveness, and is now available locally. Unlike other forms of spinal surgery, full endoscopic spinal surgery offers the smallest incisions and the fastest recovery time.
Q: Is endoscopic spinal surgery widely available? Do other spinal surgeons and physicians offer endoscopic spinal surgery to patients?
A: Many physicians have taken an interest in minimally invasive spinal procedures. As a new approach to treatment, endoscopic spinal surgery requires a different set of skills and training than traditional open surgery. Our physicians have years of experience in x-ray imaging, placement of needles and small tubes used in endoscopic spinal surgery, and performing procedures on awake lightly sedated patients without having to use general anesthesia or perform open surgery. Because of its many advantages, endoscopic spinal surgery is changing the practice of spinal medicine just as modern day cardiology has changed cardiac medicine with safer, less invasive procedures to treat patients with angina and other heart diseases. Pain management specialists, radiologists, and surgeons with specialized training and experience routinely perform endoscopic spinal surgery with safety and skill in specialized centers all over the world.
Q: What are the advantages of endoscopic spinal surgery over traditional open spinal surgery? Is it as effective as open spinal surgery?
A: Many of the problems associated with traditional spinal surgery result from the amount of surgical trauma required to gain access to the spine to treat spinal diseases such as herniated discs and spinal stenosis. Open surgical access causes more pain than endoscopic surgical access, and general or spinal anesthesia is necessary, often requiring hospital admission. Anesthesia and larger incisions may cause problems for elderly patients and those with preexisting health problems. Also, because more tissue and bone has to be removed during open spinal surgery, more injury to the spine and supporting tissues results. In some cases, the amount of bone that must be removed requires spinal fusion to be performed to counteract the weakening caused by surgery. In many patients with spinal stenosis, a primary objective of endoscopic spinal surgery is to avoid the risk, expense, and complications of spinal fusion. Recent studies show that spinal fusion operations are frequently overused, when simpler, less extensive operations including endoscopic spinal surgery may offer equal benefit to patients.
Bleeding, infection risk, recovery time, and cost are all increased by the size and scope of any surgical operation. Since full endoscopic spinal surgery is performed through a small lighted tube no larger than a pencil under local anesthesia, most of the problems associated with open surgery are minimized or avoided altogether. Also, because patients are comfortably sedated and able to respond to the physician, compressed nerves can be well protected, and relief of nerve pain and sciatica can be confirmed before completion of surgery. At least 3 randomized, controlled clinical trials have shown that full endoscopic spinal surgery is as effective as open spinal surgery in patients for whom it is appropriate. Full endoscopic spinal surgery is also cost effective. The cost of our endoscopic spinal surgical procedures is considerably less than corresponding open spinal surgery and recovery is typically only 2-3 weeks, as compared to 6-8 weeks or more following open surgery.
Q: Are all patients candidates for full endoscopic surgery? Who is not a candidate?
A: As in all areas of medicine, not all patients with herniated discs and spinal stenosis are candidates for minimally invasive procedures, and some patients will still require open surgical treatment. These patients include: patients with advanced spinal deformity, high grade instability or “slippage”, spinal trauma, cauda equina syndrome, and some unusual types of complex disc herniations. This means that 90% of patients with herniated discs and lumbar spinal stenosis are excellent candidates for endoscopic spinal surgery instead of open surgical operations.
Q: What other services do you provide for patients with spinal pain problems and related disability?
A: In addition to patients with herniated discs and spinal stenosis with sciatica, most patients with back pain and no evidence of a pinched or damaged nerve do not require surgery at all. After proper diagnosis and treatment of the cause of spinal pain, the majority of these patients may enjoy extended pain relief and improved function without the need for long term narcotic medications or repeated short term spinal injections of questionable benefit. Our primary goal is to increase functional rehabilitation and decrease costs, treatment related complications, and chronic dependency on medical treatments and providers.
Q: What about workers compensation patients? What can you offer industrial clients and workers dealing with spinal pain issues?
A: Injured workers with spinal pain and related disability cost industry millions of dollars in direct medical costs, legal expense, and lost productivity each year. In addition, ineffective therapy which prolongs recovery beyond one year dramatically decreases the likelihood that an injured worker will ever return to work. For patients with typical spinal injuries resulting from industrial accidents, including herniated discs requiring endoscopic surgery, Synergy Spine Center offers treatment programs which allow return to work or initiation of disability proceedings within 12 weeks from the initial visit. Patients treated in this manner allow employers to avoid the additional costs of litigation, prolonged case management expense, and lost productivity associated with delayed recovery.