Patients suffering from spine disorders are now offered a better alternative to the traditional open back surgery – endoscopic spinal surgery or minimally invasive spine surgery. This surgical procedure is a less invasive endoscopic procedure which utilizes specialized video cameras and surgical instruments penetrating into the back, chest or abdomen to gain access to the spine through small incisions of less than 2cm, to perform the surgery. Endoscopic techniques are not new to neurosurgeons as they have been used in the past to help in the diagnosis process of some diseases or disorders. Between the ‘70s and the ‘80s, endoscopic procedures were improved and enhanced allowing both diagnosis and treatment for certain diseases including spine disorders.
Endoscopic Spinal Surgery
Much like the arthroscopic surgery of a joint, less invasive spine surgery has made significant advancement over the past ten or so years from just being able to look at the operative area, to the ability to repair and correct a host of complex problems associated with the spine or the spinal cord. Endoscopic spinal surgery is a less intrusive procedure using a specialized video camera and an endoscope inserted into the body of the patient through small incisions to reach the target operative area. A number of back or spinal injuries are treated by this minimally invasive surgical procedure with less risk of complications.
Benefits of Endoscopic Spinal Surgery
With this minimally invasive procedure, spinal problems are addressed without having large incisions that usually need longer healing time, more prone to infection and more blood loss. With small incisions, damage to the surrounding tissues and muscles are prevented allowing for faster recovery and healing.
Additionally, endoscopic spinal surgery has low patient risk, high success rates and faster return to normal activities. It is normal to see patients moving about a few hours or a day after the surgery. Scarring is also reduced since there are no large incisions made and post-operative pain is lessened and therefore the need for pain medications is reduced as well.
Conditions Requiring Endoscopic Spinal Surgery
Endoscopic spinal surgery is recommended for patients with a herniated vertebral disc. This means that the inner part of the disc is pushed to protrude through the outer part, which is the cause of pain and pinching major nerves that could cause severe pain and numbness. There are cases when this condition does not need any surgery. However, when pain becomes severe and intolerable, endoscopic or minimally invasive spine surgery will be required. Other conditions that require endoscopic or minimally invasive spine surgery include spinal stenosis which results from some type of arthritis of the spine, and scoliosis.
Post-Operative Care for Endoscopic Spinal Surgery
Endoscopic spine surgery requires minimal post operative care. Depending on the health condition, and personal preference of the patient, after the surgery, patients can either immediately go home or stay a night or two at the hospital. Patients who have undergone anterior endoscopic spinal surgery stay a bit longer in the hospital. Some may also require physical therapy. And before the patients leave the hospital, the physical and occupational therapists give proper instructions to the patients on some techniques and ways to avoid strain injury which could be bad for the surgical procedure.
Successful Recovery after Endoscopic Spinal Surgery
Most of the patients get up and out of bed to start walking immediately after the procedure. The activity level is restricted to walking and normal daily activities for the first 6 weeks after the surgery. Heavy lifting, twisting, turning, climbing and frequent bending should be avoided during the same time. Past the initial 6 weeks, patients can start an exercise and physical therapy program to achieve speedy recovery and strength. A slow and gradual increase in usual activities will be done in the next three months. At about the same time, low impact sport activities can also be initiated.
Other Types of Less Invasive Spine Surgery
Patients with trauma, spinal tumors, degenerative disease or deformity should be evaluated and assessed by a neurosurgeon to determine if the patient is a candidate for endoscopic spinal surgery.
The surgical procedure used to remove herniated disc material pressing on the spinal cord or a nerve root is known as discectomy. In microdiscectomy, a special microscope is used to get a view of the nerves and disc. By having a larger view, the neurosurgeons can use a smaller cut causing less or no damage to the surrounding healthy tissues. During discectomy, the neurosurgeon removes the herniated disc which is pushing into the spinal canal. Loose fragments of the disc are also removed.
Patients with symptomatic and painful lumbar spinal stenosis require microlaminectomy. Large, arthritic bone spurs or otherwise known as osteophytes that compress the spinal nerves are removed using microlaminectomy. Some neurosurgeons perform lumbar laminectomy without using a microscope but this would involve long hospital stay and longer recovery period. On the other hand, microlaminectomy is performed using a small, poke-hole cut with minimal dissection to accomplish a lumbar decompression of three spinal levels or less. This minimally invasive procedure allows for a faster recovery and improved long-term outcome and less muscle and tissue damage.
This is a type of minimally invasive spine surgery which helps relieve pressure on the spinal nerve roots and the spinal cord. This decompression is achieved by enlarging the opening called foramen where the spinal nerve roots exit the spine. In microforamenotomy, neurosurgeons use specialized instruments that would make tiny incisions to lessen the damage to the muscles at the back. Like the other types of endoscopic spinal surgery, this surgical procedure offers reduced risk of infection, less time required to recover and less post-surgery pain.
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