Back pain affects every aspect of your life, yet the thought of open back surgery with the pain and extensive recovery time is frightening. Thus Endoscopic Spine Surgery techniques have been used for several decades, but these were exclusively for diagnostic purposes. In the late 1970s and early 1980s, endoscopic techniques were advanced so that both a diagnosis could be made and the disease could be treated. Endoscopic spine surgery aims to reduce tissue trauma, prevent iatrogenic problems and preserve spinal segmental motion and stability.
What is Endoscopic Spine Surgery?
Endoscopic Spine Surgery refers to the use of specialized video cameras and instruments which are passed through small incisions (less than 2 cm) into the chest, abdominal or joint cavities to perform surgery. Endoscopic Spine Surgery gives the surgeon the ability to treat a number of back or spinal injuries with as little damage to the tissues surrounding the area as possible. Endoscopic surgery also results to lesser blood loss and lowers rates of complication. Since this type of spine surgery only needs small incisions (less than 2cm) then there is less scarring.
The Purpose of Endoscopic Spine Surgery
Endoscopic spine surgery reduces spine trauma, prevents iatrogenic problems and preserves spinal segmental motion and stability. The most compelling benefits of endoscopic spine surgery over open surgery are smaller incisions and less tissue trauma, less postoperative pain, minimal blood loss and earlier return to normal work routine. Endoscopic spine surgery procedures are performed for successful surgical treatments of lumbar and cervical disc herniation, an operational endoscope is used as a gold standard, when traditional spine treatment fails to give positive post surgery results.
Medical Conditions for Endoscopic Spine Surgery
Endoscopic Spine Surgery has been and is employed predominantly for the treatment of the following medical conditions:
Lumbar, thoracic and cervical disc herniations with radicular symptoms
Lateral spinal canal (recess) and foraminal stenoses with radicular symptoms
Degenerative facet joint cysts with radicular symptoms
Diagnosis for Endoscopic Spine Surgery
With each of the above-mentioned conditions, a clear clinical picture complemented by the patient history and a thorough physical and neurological examination is the minimum standard. Given the prevalence of degenerative changes seen on radiographs and magnetic resonance imaging (MRI) in asymptomatic individuals, imaging studies alone can be extremely misleading when the pathological findings on such studies are not clearly matched to specific clinical symptoms. With cervical as well as with lumbar spinal pain syndromes, the clinical examination needs to also cover the shoulder girdle and the upper extremity or the pelvis, the sacroiliac joint and the hip joints, respectively. It is not rare, that painful conditions in these adjacent regions mimic symptoms caused by spinal conditions.
In equivocal situations, the use of fluoroscopy-guided, contrast-enhanced diagnostic injections are recommended in order to ascertain a diagnosis that is amenable to endoscopic spinal surgery. Adequate and recent imaging studies are required and an up-to-date spinal MRI or computed tomography (CT) wherever MRI is not an option any older than 3 months should be available for surgery. In cases with changing symptoms, a repeat study prior to surgery is recommended. Supplemental neurophysiologic studies (electromyography, neurography, etc.) may be helpful if the diagnosis of a monoradicular lesion is still uncertain based on patient history, clinical examination and imaging studies.
Preparing for Endoscopic Spine Surgery
To prepare for Endoscopic Spine Surgery, quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have. Your doctor will perform a clinical examination and possibly a few tests prior to surgery to see if you are a candidate for the procedure. These may include an MRI, discography, CT scan and X-rays. Tell your surgeon what medications you are taking and ask if you should stop taking them before your operation. If you smoke, stop smoking as this slows the ability of bone to grow and repair adequately. To make your recovery easier, prepare your home for life after surgery. Arrange for someone to help you at home after surgery. You'll most likely be told not to eat or drink the night before the surgery.
Common Procedures for Endoscopic Spine Surgery
The following are the common procedures for Endoscopic Spine Surgery procedures:
Endoscopic Lumbar Discectomy (ELD): An endoscopic lumbar discectomy, also called a Microendoscopic discectomy (MED), is a minimally invasive surgery in which herniated disc material is removed. A herniated disc occurs when one of the discs that separate and cushion the vertebrae of the spine, usually but not necessarily in the lumbar region, bulges or rips. This may also be called a ruptured disc or a slipped disc and is usually caused by the combination of age and chronic strain on the back. An endoscopic discectomy is a minimally invasive approach to herniated disc surgery. The procedure usually requires only a local anesthesia, so that the patient stays conscious throughout the surgery. The surgeon will make a half inch to one inch (1.3-2.5cm) long incision in the back at the site of the slipped disc and insert a wire through the incision to the spine. Instead of cutting the muscles, dilators are pushed into the back along the wire to stretch the muscles into a one inch (2.5cm) circular opening. A retractor is then implanted to hold the muscles open for the procedure. The surgeon then inserts a hollow endoscope into the back between the vertebrae that sandwich the ruptured disc. An endoscope is a flexible or rigid tube with a lighted viewing device that transmits the image to a fiberscope or screen so that the doctor can see inside the body without conducting open surgery. The surgeon then inserts instruments through the hollow tube and makes a small opening through the muscle and bone to access the disc. The disc fragments are then removed and the in tact part of the disc is left to heal on its own. The incision will be dressed with antibiotics and may require one or two stitches or none at all.
Endoscopic Cervical Discectomy (ECD): Endoscopic cervical discectomy is a minimally invasive spine surgery that is usually done as an outpatient procedure using a local anesthesia so the patient can remain awake. Most patients feel immediate relief from pain following the procedure. Walking is permitted the same day and the patients are discharged from the surgery center that afternoon. Following your discharge, a physical therapy program near your home is recommended. Little, if any, postoperative medication is required for most patients. Normal activity can usually be resumed within one to six weeks after the surgery. The surgeon inserts a specially designed endoscope, a small tube with a camera, into the neck where the spinal condition or disc problem such as annular tear, bulging disc, or herniated disc is located. The surgeon can treat the portion of the disc that is compressing the nerve with a laser if the bulge or tear is small, or remove it through a small incision using an endoscopic tube designed for this purpose. After the damaged portion of the disc is removed, a laser vaporizes the surrounding problem area, then shrinks and remodels the remaining disc. Most patients get immediate relief after having an endoscopic discectomy. Rehabilitation - including walking as well as head and neck support -can begin within hours of surgery. Patients experience far less trauma, risk and pain than with traditional open back discectomy, so patients get back to life sooner. Finally, because the procedure is performed on an outpatient basis, you will be allowed to return home the day of the surgery. Patients are normally seen in our clinic/office Day one, surgery is performed Day two and on Day three patients are once again evaluated after which they can return home.
Endoscopic Lumbar Foraminotomy: This procedure is considered a minimally invasive procedure which doesn't require general anesthetic and can be performed in an outpatient surgical setting. With the patient in a position, granting access to the back, a small incision is made and a local anesthetic is administered. A round depuy tube is inserted into the incision with a series of larger tubes being placed over it, eventually increasing its size to about 18 millimeters in diameter (about as large as a whiteboard marker). The surgical instruments used during the procedure will gain access to the patient through this tube. They include the laser, camera, suction, irrigation and other surgical instruments. Because this process moves or pushes the muscles and tissues instead of cutting or tearing them, minimal scar tissue will develop during the healing process. When the working tube is secured the process of removing the portion of problematic bone or tissue can be accomplished. A foraminotomy is a relatively quick and pain free procedure with many patients acknowledging pain relief as the affected nerve is “freed". After the surgeon has successfully freed the nerve, the working tube is slowly removed from the patient allowing for the muscles to move back into their correct position. The incision is then closed with one to two stitches. After one or two hours of monitoring, the patient is released (accompanied by a companion). The recovery process begins that very evening as patients are advised to go for a long relaxing walk. There are many advantages to having minimally invasive surgery such as not having to endure a lengthy hospital stay, reduced risk of infection, no need for general anesthetic, fast recovery from the procedure and minimal amount of scar tissue formed.
Cervical Endoscopic Foraminotomy: This procedure relieves spinal nerve root compression by creating more room for the nerve root to pass through the foramen. When disc material compresses the nerve root on one side (unilateral compression), the cervical foraminotomy can be used to remove the portion of the offending disk. When a bone spur narrows the foramen and compresses the nerve root, a posterior cervical foraminotomy can be used to chisel away the spur to widen the passageway. Some refer to this procedure as minimally invasive, in that the incision is relatively small and no fusion of the spine is required. The procedure is performed in the back of the neck, which means that you will be lying face down on the operating table. You will be under general anesthesia so that you will feel nothing during the procedure. The spinal surgeon will make a small 1 to 2 inch skin incision and with the help of magnification, he/she will dissect away soft tissue on the side of the compression. Precision instruments are used to carefully remove a small amount of bone which serves as the outer wall of the foramen. Once the foramen is opened, the nerve root can be seen. In cases of compression due to disc material, the nerve root is gently lifted and the disc material is removed. The wound is then closed, and the surgeon may provide you with a soft collar. A variation of this technique is a truly minimally invasive procedure where the surgeon may use an even smaller skin incision and use a tubular retractor to access your spine. Regardless of which approach, standard skin incision or with minimally invasive tubes, posterior cervical foraminotomy provides relief of nerve root compression with minimal bone removal. Symptomatic relief is seen in 85- 90% of cases. Some patients may require a short course of post-operative physical therapy.
Laser Facet Rhizotomy: Also called as Endoscopic Facet Rhizotomy (Lumbar) provide relief even when other treatments have failed if you suffer from a spinal condition or back pain caused by: bone spurs, chronic lower back pain, facet joint arthritis, facet hypertrophy, failed back and neck surgery, facet joint injuries, whiplash syndromes. If you suffer from these conditions and have had lower back pain for more than six weeks that has not responded to other treatments, Laser Facet Rhizotomy / Endoscopic Facet Rhizotomy (Lumbar) may be the solution to your back pain. Laser Facet Rhizotomy is a minimally invasive spine surgery usually done as an outpatient procedure while the patient is under local anesthesia. During the procedure, the spine surgeon makes a small cut (7 mm) to insert an endoscope into the targeted location. The endoscope, a small flexible tube with a video camera, is placed so the small nerve branches (medial branch), which only have sensory function, can be easily seen. The surgeon then uses a laser to deaden these nerve branches thereby eliminating the patient's pain. Laser Facet Rhizotomy can completely eliminate pain because it literally deadens the sensory nerves that detect pain in a specific area making it an option for patients who suffer from severe or chronic pain that has not responded to other treatments. The disadvantage of Rhizotomy is that it also blocks other normal feeling in the area.
Post-Operative Care for Endoscopic Spine Surgery
Post operative care for Endoscopic Spine Surgery is minimal. Usually, a physical therapy is recommended in patients' local area. Most patients usually return home within two days after the surgery. Some patients typically stay longer, approximately three to four days, if an anterior endoscopic spinal surgery is also performed. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger.
Benefits of Endoscopic Spine Surgery
The most compelling Benefits of Endoscopic Spine Surgery are:
Smaller incisions and less tissue trauma
Minimal blood loss
Earlier return to activities and work
Easier operative approach in obese patients
Local or regional anesthesia combined with conscious sedation can be used
In most cases, less postoperative pain medication is required
As a consequence, outpatient procedures are possible
Risks of Endoscopic Spine Surgery
Any surgical procedure can be associated with risks. An endoscopic spine surgery may involve risks including inter operative complications, infection, bleeding, hardware failure etc.
Recovery after Endoscopic Spine Surgery
Successful recovery from a Endoscopic Spine Surgery requires that you approach the operation and recovery period with confidence based on a thorough understanding of the indications, alternatives, and risks of your procedure. Most patients are able to get up out of bed and start walking shortly after surgery, usually on the same or following day. For the first 6 weeks, the activity level is limited to walking and normal daily activities. Most patients are encouraged to avoid heavy lifting, frequent bending, twisting or turning or climbing during the first 6 week period. After 6 weeks, patients begin a physical therapy and exercise program to achieve rapid recovery and strength. By 3 months a gradual increase in normal activities as well as the institution of low impact sporting activities can be started. At 6 weeks, all activities are begun, including sports.
Endoscopic Spine Surgery in India
India has emerged as a new centre for back treatment through various procedures of Endoscopic Spine Surgery. It provides internationally accredited surgical facilities for the surgery. The Indian spine surgery hospitals offer a wide range of premium healthcare services at affordable costs which include orthopedic consultation, diagnosis, treatment, rehabilitation and physiotherapy.
Endoscopic Spine Surgery in India comes from high profile medical team with world class surgeons having massive experience. The high quality, training and specialization of orthopedic surgeons and medical staff contribute to India being a worldwide reference in almost all medical procedures. India has one of the worlds best equipped hospitals and highly skilled surgeons.
Every year thousands of international patients come down for various medical treatments and surgeries in India. The hospitals and clinics delivering Endoscopic Spine Surgery in India are spread all over the country with presence of the most advanced medical centres and hospitals in the world. These are available at hospitals in the following cities:
Cost of Endoscopic Spine Surgery in India
Not only the global patients get the Endoscopic Spine Surgery in India at a mere fraction of the cost but there are no long and unreliable waiting lists to follow. The cost difference is very vast which goes from 60-80% less as compared to medical treatments performed in USA and other developed nations. The following table can give you a fair idea of the cost difference which is evident in India.
Procedure Cost (US$)
Endoscopic Cervical Discectomy (ECD)
Endoscopic Lumbar Foraminotomy
Cervical Endoscopic Foraminotomy
Some of the common countries from which patients travel to India for surgery are:
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