Minimally Invasive Surgery

Minimally Invasive Surgery

Endoscopic and Minimally Invasive Surgeries

At American Spine, we specialize in many types of endoscopic and minimally invasive surgeries including:

  1. Endoscopic Foraminotomy - To relieve pressure on nerves compressed by the intervertebral foramen.
  2. Endoscopic Decompression - lumbar, thoracic, cervical with or without fusion and instrumentation (anterior, posterior) - lumbar, thoracic and cervical
  3. Endoscopic Laminotomy - To relieve pressure on the spinal cord compressed by spinal stenosis.
  4. Transforaminal Endoscopic Discectomy - To remove the portion of a herniated or bulging disc that is pressing on a nerve root or the spinal cord through a natural opening known as Kambin's Triangle. Surgeons utilize X-ray monitoring and fiber-optics endoscope in order to see precisely what is compressing the nerve and to remove it without removing normal healthy tissue and destabilization the spine.
  5. Percutaneous Discectomy - often times a disc herniation is small and requires the least invasive surgery. This procedure can be done mechanically or using laser to remove and decompress the pain generating disc

How is endoscopic surgery performed?

A unique aspect of American Spine's surgical procedures is that they require a tiny incision. In the operating room, a small, 6 to 9-millimeter incision is made and a series of tubes, increasing in size, are placed over one another until a final tube is positioned onto the area to be operated on. This does not require tearing or cutting muscle. The last tube, or "working tube," is 6 or 9-millimeters in diameter and once it is in place, the arthroscope with a video camera attached to it is inserted into the tube up to the operative site. A variety of instruments, including but not limited to mechanical graspers, automated shavers, radiofrequency ablation, and laser are used to remove the offending part of the disc or facet joint. Endoscopic spine surgery is technically demanding and requires an entirely new and different set of skills than traditional open spine surgery. Throughout the procedure the patient's nerves are monitored by neuromonitoring EMG, additionally the monitors the vital signs and administers medication. A surgical technician stands by the surgeon to assist with instruments. and a circulating nurse is present to coordinate the activities of the operating room team, communicate with the patient.

How long does surgery typically last?

The average endoscopic spine procedure lasts about 45-60 minutes. When the surgeon is sure that the nerve is free and everything is completed, the instruments are removed to let the tissue and muscle go back to their natural position. Then one or two stitches are put into the tiny surgical site and the surgical site is dressed in sterile fashion. The patient is wheeled into the post-anesthesia care area where their vital signs are monitored, medications and light refreshments are given. The patients are encouraged to walk after the surgery once the patient recovered from the sedation or anesthesia. Soon after, they are discharged home with a prescription for post-operative pain medicine and detailed instructions about what to do, what not to do, and what to look out for. The patient is usually followed up 1-2 weeks after the surgery.

What's the recovery process like?

The patient is encouraged to take it easy during the first week of surgery, but encourage to walk in the house frequently and perform simple upper and lower limb exercised as tolerated. After 1-2 weeks of rest and recovery, the patient returns for a postoperative appointment. An epidural injection may be given to reduce swelling and increase range of motion. Physical therapy may be recommended 3-4 weeks after surgery. Physical therapy initially consists of a series of stretching exercises, walking, ice or heat, gentle electronic stimulation or relaxing massage. Each patient is given a home exercise program by physical therapy. Over the next 1-2 months, there is gradual and continuous improvement, as the nerves and discs heal. With time, proper nutrition and exercise, the body can repair any damage, gain strength, and a gradual increase in daily activities occurs. Patients are encouraged to quit tobacco and lose weight if necessary especially during the recovery process.

A patient recommendation...

To Whom It May Concern:

I, Kathryn Webster (Senior Therapist at the Chopra Center For Wellness) had a Discectomy 15 months ago by Dr. Sial.

Prior to surgery, I was in daily chronic pain. This pain was lodged in my lower back accompanied by shooting excruciating pain radiating down the right side of my thigh, rotating down the front of my calf down to the top of my foot. Due to this, I lost many days of work. I was unable to drive or sit for more than 15 minutes. Finally, I was so incapacitated by my pain, I was soon to be crippled.

I made the best decision of my life. I had the procedure, A Discectomy. The surgery lasted 3 hours, I was conscious with very little discomfort. After the procedure was finished I was immediately pain-free. My down time was only 24 hours and I Resumed my life to the fullest without pain and remain so to this day. I highly recommend this procedure to anyone who can relate to my life debilitating condition.

If you have any questions or concerns, Please call the American Spine & American Spine at (951) 734-PAIN (7246).