Endoscopic spine surgery (ESS) is an effective treatment option when you require relief from pain resulting from a disc tear or bulging, extruded, protruded, or herniated disc irritating and compressing the spine. You should try minimally-invasive methods like ESS, spinal fusion, microdiscectomy, or laminectomy rather than opt for conservative or minimally-invasive spine techniques. ESS can relieve back and leg pain, treating painful health conditions without many complications and the extended recovery periods associated with conservative surgical techniques.
However, you must go to a professional for this procedure to succeed. At the LAMIS Institute, we have experienced physicians who can conduct ESS and deliver the best possible results. Our neuro-surgeons have traveled and trained with the most innovative leaders in ESS. Our procedures now address the everyday painful conditions affecting patients. If you seek to undergo this procedure in Los Angeles, we invite you to contact us for a consultation, where we will evaluate your health condition before starting the treatment.
Defining Endoscopic Spine Surgery
ESS is a less invasive surgery for alleviating chronic leg and low back pain. This modern spine surgery uses an endoscope with an attached light source and a high-definition camera inserted via a tiny incision (a quarter inch) to the targeted spine area where the pain originates.
The procedure allows orthopedic surgeons to operate accurately and safely, offering patients the best possible results. The surgeon observes the spinal cord on a high-definition monitor and operates via the endoscope, utilizing specialized micro-equipment such as graspers, a radiofrequency probe, or a laser. An endoscope is a camera inserted into the spinal cord through an incision. It enables the surgeon to view the inside of the spinal cord and make the required repairs.
ESS provides patients with a shorter recovery time. Additionally, the patient will not experience the recurring pain they would experience if they had undergone conservative spine surgery.
Conditions Treatable By Endoscopic Spine Surgery
ESS can treat several conditions, including spinal stenosis, degenerative disc disease, facet joint syndrome, sciatica, failed back surgery syndrome, and herniated discs. Additionally, it can decompress spinal nerves, relieving pain.
Spinal stenosis arises when, often because of the body's age, the spinal canal narrows, exerting pressure on essential nerves in the spine. Spinal stenosis is known as lumbar stenosis when it occurs in the lower back area, thoracic stenosis in the middle to the upper part of the back, and cervical stenosis when it occurs in the neck area.
The narrowing can occur for various reasons, like excessive bone growth or cartilage and ligament thickening in the spinal canal, making the opening more slender with time. The risk of this problem increases when a person is fifty years of age and older, partly because of years of stress on the spinal cord and the likelihood of bone and tissue becoming less flexible and sturdy with several years of repeated use.
Spinal injury or bone disease may also lead to spinal stenosis in patients of any age.
Degenerative Disc Disease (DDD)
DDD involves various molecular, nutritional, biochemical, and structural changes that arise in the spinal disc with time or after a trauma to the intervertebral disc in the spine.
DDD is a prevalent reason for neck and back pain, radiculopathy, and sciatica. Back pain due to DDD comes from compressed or inflamed nerve fibers and can be classified as mechanical instability.
Herniated discs can cause neck or back pain and leg or arm discomfort and may progress into complicated syndromes like myelopathy, sciatica, or radiculopathy. Pain caused by a herniated disc is known as discogenic pain.
A person's spinal column has twenty-three intervertebral discs. The discs are tissue joints comprising a hydraulic jelly-like core termed the nucleus pulposus covered within a hard external wall called the annulus fibrosus. These discs safeguard the spinal nerves and vertebrae from unexpected impacts. They also absorb shock from spinal movements such as twisting, jumping, and bending.
Unluckily, the annulus fibrosus (the disc's external wall) can develop an annular tear (traumatic tear), making the gelatinous nucleus pulposus push back through the tear and into the neural foramen or spinal canal. The section of the gelatinous nucleus pulposus that pushes the tear is known as herniation. Mostly, this hernia impinges on a spinal nerve, causing irritation and inflammation of the nerve.
Candidates for Endoscopic Spine Surgery
If a spinal cord condition is causing you pain and conservative treatment has failed, you may be a suitable candidate for ESS. ESS has excellent results in treating failed spine surgery, foraminal stenosis, facet joint syndrome, and a herniated disc.
Types of ESS Procedures
There are various types of ESS. They are:
- Endoscopic Laminotomy— this surgical procedure is suitable for patients with lumbar spinal stenosis who are not responding to traditional treatment options. Lumbar spinal stenosis happens when the spinal canal narrows around the spine, exerting pressure on the nerves and spinal cord. During the endoscopic laminotomy procedure, the doctor opens the lamina below and above the spinal disc to decompress the nerve.
- Endoscopic Rhizotomy— if a patient suffers from chronic muscle spasms or low back pains, the endoscopic rhizotomy procedure can relieve pain. This procedure can treat chronic axial back pain. A patient with chronic axial back pain may feel fine when they lean forward but feel spasms and severe pain when leaning backward. Candidates for endoscopic rhizotomy may have experienced short-term relief from a percutaneous medial branch rhizotomy. The surgeon uses laser light to destroy the medial branch nerve, realizing a better lifelong outcome than they would achieve with a percutaneous rhizotomy.
- Endoscopic Foraminoplasty— this procedure relieves pressure from the spinal cord itself or an existing nerve. The pain could be from bone spurs, scar tissue, and a herniated/slipped disc. This procedure treats facet disease, foraminal stenosis, and DDD.
As the area between the disc facets becomes smaller, the opening in the spine for the spinal nerves narrows. This compresses the nerves located inside and causes pain. Endoscopic foraminoplasty utilizes microscopic surgical equipment to extract part of the bone and open the foramen. This will relieve the pressure on spinal nerves.
- Transforaminal Endoscopic Discectomy— is performed to relieve the pain caused by protruding, extruded, bulging, or herniated discs. The surgeon uses an endoscope to decompress the disc, relieving the pressure on the spinal nerves causing the patient pain.
- Endoscopic Annuloplasty— if a patient has tears in the annular walls of their disc, endoscopic annuloplasty can treat the nerves growing into the disc leading to pain, and give relief without having to undergo spinal fusion. Tears in the annular walls of the disc can result in severe pain since nerves start to grow in those tears. This surgical procedure enables the surgeon to look for these tears with an HD camera and treat them using laser light to destroy the nerves and close the tear, doing away with painful symptoms.
The surgeon will slightly sedate you with intravenous medication and position you comfortably on the operating table. They will then numb the skin in the area where the surgery will take place so that you are comfortable throughout the procedure.
With x-ray guidance, the surgeon will guide a guidewire and surgical needle to the spinal disc experiencing pain. The surgeon will then make an incision and carefully separate the muscles to create a small pathway for the endoscope to reach the spine. Then, they gently place a cannula and metal dilator on the guidewire down to the spinal disc to determine the surgical site. The dilator and guidewire are removed.
The images captured by the endoscope camera are cast onto a computer, allowing the doctor to visualize pathology and anatomy. After the projection of the images, the doctor will insert instruments via the endoscope to extract any thickened ligaments, herniated discs, or hard bone spurs to achieve nerve decompression.
Once the surgery is over, the nerves become decompressed and relieved of pressure. The surgeon will then administer a steroid injection through the endoscope to minimize postoperative inflammatory pain and promote patient comfort. The cannula and endoscope are taken out, and the doctor stitches the incision site before applying a bandage.
The surgeon will then transfer you to the recovery room and observe you for one or two hours before being discharged. The success rate of this surgery is high, with patients generally recording improved function and a significant decrease in pain.
Generally, the side effects of this procedure are mild and disappear within a short period. The most prevalent side effects are bruising, swelling, and pain around the incised area. Additionally, you might have temporary tingling, weakness, or numbness in your legs or arms.
Benefits of the Endoscopic Spine Surgery
The endoscopic spine surgical procedure effectively relieves lower back pain, sciatica, and herniated discs. Since it entails tiny incisions, patients recover more quickly than traditional, less invasive spinal cord surgery. The benefits of this surgical technique include the following:
- It is an alternative to spine fusion in certain patients
- The procedure is minimally invasive— ESS is done through a tiny cut, which means minimal tissue damage. A small incision also means minimal postoperative pain and less pain medication required.
- Reduced infection risk after the operation— ESS has a minimal infection risk due to the tiny size of the incision. Additionally, the procedure does not necessitate the placement of any foreign objects like implants in the body.
- Local anesthetic and conscious IV sedation mean less risk, avoiding general anesthesia.
- Shorter recovery period— patients recover rapidly from ESS. ESS has little to zero tissue trauma compared to conservative techniques that lead to substantial tissue injury. This translates to a shorter stay at the hospital and a quicker resumption of daily activities, including going to work.
- Reduced scarring on the skin and internally
- The procedure preserves the spine and muscles
- Less blood loss
- It is an outpatient procedure— patients generally leave two hours after the procedure.
Endoscopic Spine Surgery Risks
Endoscopic spine surgery is a less invasive surgical technique with many advantages for patients. But like any surgical procedure, ESS also has risks. The most prevalent risks of ESS include nerve damage, bleeding, and infection.
- Nerve damage— a slight risk of nerve damage is associated with ESS. The risk is lower than in other forms of spinal cord surgery.
- Infection— even though there is a low infection risk with ESS, there is a likelihood, like with any surgical procedure
- Bleeding— ESS involves utilizing small cautery and instruments to prevent bleeding. There is a slight chance of bleeding accompanying this surgical process.
If you wish to undergo this surgical procedure, ensure you discuss the benefits and risks with your doctor.
The Cost of the Procedure
Endoscopic spine surgery is minimally invasive and has a shorter recovery time than conservative open spinal surgery. This procedure can also treat a wide range of conditions. The cost of this procedure varies based on how severe your condition is and the kind of procedure you require. Whereas insurance generally covers the treatment, you might need to pay a copayment or deductible.
Endoscopic Spine Surgery Vs. Minimally Invasive Spine Surgery
Although ESS is a less invasive surgical procedure, some critical differences exist between ESS and minimally invasive spine (MIS) surgery.
Minimally Invasive Spine surgery is the standard of care in spinal cord surgery. It represents a broad spectrum of surgical procedures, with endoscopic surgery being the least invasive. MIS is as highly effective as ESS in treating painful spinal cord conditions.
But unlike MIS, ESS significantly minimizes trauma to the patient's soft tissue and muscles, resulting in faster recovery. ESS uses a surgical technique that circumvents the vital stabilizing muscles in the lumbar spine.
Another key distinction is the incision size. Unlike the incision made during the MIS (one or more inches), the ESS utilizes a quarter-inch cut. This means ESS has a brief recovery period than MIS. Tiny surgical cuts and avoiding vital lumbar spine muscles can improve patient treatment results significantly.
ESS can be done faster, giving the orthopedic surgeon better access to the spinal disc and nerves and high visualization. Additionally, ESS does not require general anesthesia. This allows for a quick discharge from the hospital (within two to three hours of the procedure), and the patient faces less risk.
Find Professional Neurointerventional Services Near Me
At LAMIS Institute, we are a well-equipped clinic in Los Angeles that performs ESS for patients requiring treatment. We have renowned neurosurgeons who are pioneers in this treatment procedure. If you entrust your case with us, you can rest assured that you are in safe hands. Call us at 310-734-6088 to begin your journey to relieving back, neck, and even leg pain.