If Your Surgeon Recommends A Spine Fusion, Endoscopic Spine Surgery May Be An Excellent Spine Fusion Alternative.
Suffering from back or neck pain can significantly change one’s quality of life and daily physical routines. When conservative efforts such as rest, physical therapy, or chiropractic care have been exhausted, patients are referred to pain management and most times a spine surgeon. However, there is a significant gap between pain management and spinal surgery.
A new group of surgical techniques called least invasive spine surgery has been developed over the past 15-20 years utilizing endoscopic spine surgery. The benefits of these surgeries have genuinely reduced the number of spinal fusions in patients suffering from degenerative disc disease, chronic low back pain, sciatica, and herniated discs.
The first step in most patient’s pain journey is to have a pain management doctors diagnose and confirm that the pain is originating from the spine. Second, pain management doctors utilize therapeutic injections and procedures to offer patients some pain relief. These procedures can be therapeutic for many patients; however, most patients tend to receive short-term relief. Often times patients have multiple rounds of injections and procedures but never achieve long-term pain relief. If pain often returns and their suffering becomes severe, patients will usually be referred to a spine surgeon for further evaluation.
Dr. Rodriguez administering an anesthetic injection to the skin to minimize pain.
Minimally Invasive Spine Fusion Surgery
Dr. Rodriguez performing an MIS surgery.
When spine surgeons see a surgical candidate, they typically use minimally invasive spine surgery (MIS) techniques to alleviate painful conditions. The goal of MIS fusion surgery is to stabilize the spine and relieve pressure on the spinal nerves resulting from herniated disc material, spinal stenosis, or boney spurs. Unlike traditional spine surgery, which uses large open incisions, MIS uses one to two-inch incisions through surgical approaches that minimize trauma to your muscles surrounding the spine. Minimally Invasive procedures use small tubular retractors ranging from 1 to 2 inches. These retractors gently spread the muscles, starting with smaller tubes and adding larger ones over the top of each to expose the area of the spine that the surgeon wants to work and see.
Minimally Invasive Transforaminal Lumbar Interbody Fusion.
MIS Fusion Surgery Potential Benefits Versus Open Spine Surgery Are:
- Less blood loss from surgery
- Reduced muscle damage
- Reduced risk of infection
- Faster recovery than open spine surgery
- Reduced complications and infection rates
- Shorter hospital stay 1-2 days
MIS Spine Fusion Surgery Disadvantages Are:
- Extensive muscle dilation and bone work can lead to more scar tissue formation and back pain
- Can cause adjacent level syndrome – put stress on the levels above and below the spine fusion
- Reduces mobility of the spine
- Return to work at least six weeks
1.3 inch incision resulting from an MIS spine surgery.
Recovery time associated with each MIS surgery is listed below:
- Lumbar Microdiscectomy/Laminectomy – 6 weeks
- Lumbar Fusion – 6-12 weeks
- Cervical ACDF – 6-12 weeks
Spine Fusion Alternative – Endoscopic Spine Surgery
Dr. Rodriguez performing an endoscopic rhizotomy procedure.
Too often, patients suffering from chronic back pain undergo invasive spinal fusion surgery and experience lengthy recovery times. After spine surgery, some patients suffering from low back pain, struggle to return to work and in some cases get little to no additional relief. In the past 15-20 years, a small percentage of orthopedic spine surgeons, including Dr. Marco Rodriguez, have identified a gap in treating patients who get limited pain relief from pain management and invasive spine surgery. Dr. Rodriguez has embraced the innovative and cutting edge techniques of endoscopic spine surgery as a spine fusion alternative surgery, and a way to bridge this gap in his treatment options.
Endoscopic spine surgery was pioneered and developed by Anthony Yeung, MD, an orthopedic surgeon in Phoenix, AZ. Dr. Yeung saw a need to minimize the trauma of MIS Surgery and pain experienced by his patients by introducing an endoscope attached to an HD camera, into the patient’s back through a ½ inch incision. Also, for many patients, endoscopic spine surgery has diminished or eliminated a need for spinal fusion surgery.
With the endoscope and HD camera, the trained surgeon can visualize the anatomy of the spine and selectively pinpoint the pain generating pathology. The endoscope has an internal working channel for highly specialized surgical instruments such as a laser, radiofrequency ablation probe, and micro-graspers and motorized burrs. Each instrument can selectively ablate, cauterize, and decompress herniated disc material and bone spurs while the surgeon has direct visualization of their target spinal pathology.
Dr. Rodriguez operating utilizing endoscopic rhizotomy technique for low back pain.
Because the endoscope uses a ½ inch incision, the muscle and surrounding tissue trauma are diminished more so than MIS surgery. Endoscopic spine surgery allows patients to return to work sooner, and shorter recovery times compared to MIS surgery. Endoscopic spine surgery has similar outcomes to MIS surgery in providing pain relief of symptoms. As a result, endoscopic spine surgery has a very high patient satisfaction rate. Patients should always seek a second opinion to see if they are a candidate for a spine fusion alternative surgery such as endoscopic spine surgery.
The Advantages of Endoscopic Spine Surgery:
- Spine fusion alternative in select patients
- Preserves mobility of the spine
- No general anesthesia is needed
- Less post-operative pain
- ½ inch incision – one of the smallest incisions in spine surgery
- Superior visualization of the surgical operating area
- No narcotic pain medication needed for recovery
- Faster recovery and return to administrative work – as early as two weeks
- No major muscle damage
- Minimal skin scarring
- High patient satisfaction
- No hospital stay
The post-operative incision is ½-inch. Results in minimal scarring.
Disadvantages of Endoscopic Surgery:
- Cannot treat spinal instability
- May later require more invasive options
- Less long term outcomes data
Recovery Time Associated With Each Endoscopic Spine Surgery Is Listed Below:
- Lumbar Endoscopic Rhizotomy – as little as 2 Weeks
- Lumbar Endoscopic Discectomy – as little as 2 Weeks
- Lumbar Endoscopic Foraminalplasty – as little as 2 Weeks
- Cervical Endoscopic Rhizotomy – as little as 2 Weeks
- Cervical Endoscopic Foraminalplasty – as little as 2 Weeks
When to Choose Endoscopic Spine Surgery and Minimally Invasive Spinal Fusion Surgery
The ultimate decision to have surgery is based on your symptoms, diagnosis and choosing a surgeon who offers both endoscopic and spine fusion surgery. Each spinal procedure provides unique benefits to the patient. Choosing the right procedure for your needs often depends on choosing the right surgeon. Not all surgeons offer spine fusion alternative surgery such as the endoscopic spine surgery. Therefore, it is worthwhile getting a qualified and experienced endoscopic spine surgeon’s second opinion to see if you are a candidate. Spinal Fusion is a valid and good treatment option for very select patients. Here are some examples of who is a qualified candidate for each type of surgery.
Choose Endoscopic When…
- Focal problem (single-level/unilateral problem)
- Chronic low back or neck pain related to facet joints
- Far-lateral herniation that causes one-sided leg pain
- Active and athletic patients that want to return to lifestyle sooner
- Can’t be out of work for long period of time
Choose MIS Spinal Fusion When…
- Instability of the spine
- Multiple spinal levels affected
- Reconstruction/re-aligning of the spine
- Severe spinal stenosis
- Unlikely to tolerate procedures without general anesthesia
Spine fusion surgery is not always the best option for active and busy patients. There are better options for some of these patients. If you have been offered a spine fusion, Dr. Rodriguez would like to offer a second opinion or a free MRI review to help you get the best spine care possible.