Many patients suffering from back and neck pain may not be fully aware of all available options.  Reflecting on my own experience, I did not know much about minimally invasive spine surgery until I was introduced to Dr. St. Louis.  So, I thought it would be a good idea to share an article that was featured in this month's issue of our monthly newsletter, The Spinal Column.  In this article, Dr. John Spallino discusses how endoscopic spine surgery has evolved, much like arthroscopic knee and shoulder surgery.  I hope you will find this article helpful.


Endoscopic surgery refers to the use of specialized video cameras and instruments, which are passed through small incisions into the chest, abdominal or joint cavities to perform surgery. There is a threefold benefit of endoscopic spine surgery. The actual sizes of the surgical incisions are smaller, which leads to less pain and less damage to the surrounding tissues, so the recovery from surgery is much quicker.

Endoscopic 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 condition could be treated. These techniques have now been advanced to the treatment of spinal conditions including: herniated or bulging discs, bone spurs, spinal stenosis, foraminal stenosis, and facet disease.

By using special scopes, instruments and even a laser, LSI's surgeons have been able to successfully treat spinal conditions with minimal injury to surrounding healthy tissue and muscle.  Therefore, what once required 3 to 6 months of recovery now requires 3 to 6 weeks. As with the surgical treatment of other medical conditions affecting gallbladder, knee, or shoulder, operations performed traditionally through large incisions are being performed less frequently, while the endoscopic approach is becoming the standard of care due to its overwhelming benefits.

Dr. John Spallino is a Medical Information Specialist at Laser Spine Institute. In this capacity, he facilitates patient education by conducting nationwide informational seminars, in addition to interpreting and analyzing radiographic imaging. To learn more about Dr. Spallino, click here.

Diagnostic Facet Injections

 A common diagnostic procedure in these cases is the diagnostic facet injection.  Targeted placement of anesthetic in the small "knuckle like joints of the spine" may reveal them to be the primary source of pain in many patients.  Alternatively, some patients may require a test of the intervertebral disc space, which involves stimulating the disc with fluid designed to reproduce the pain and reveal microscopic injury or disease of the disc that is frequently invisible on MRI and x-rays.
 

What Happens During the Procedure?

Spinal diagnostic tests are performed in a specialized x-ray suite, using state of the art fluoroscopic equipment.  This allows the physician to precisely steer a spinal needle toward the anatomic abnormality in question, such as a bone spur or disc.  Once accurate placement is achieved, a small amount of lidocaine is injected to temporarily remove the pain caused by that bone spur or disc.  This is the best predictor of the ultimate effect of removing the spur or disc.

The procedure is usually not painful and immediately after, the patient is typically able to move about freely.  In all cases, except the discogram, it is desired that the patient presents for the block while experiencing some of their typical pain, in order for the block to have effect upon.  Skipping a pain tablet and provoking the pain with mild activity is helpful at times.

As CEO of the fastest growing spinal surgery center in the world, I understand the implications of naming our facility the Laser Spine Institute.  While using the word "laser" in the title may help associate us with "cutting edge technology" and "innovation", it does bring a limitation that does not fully and accurately illustrate the success and abilities of our surgeons and their minimally invasive endoscopic surgical procedures.

I've spoken with numerous prospective patients who have told me that after asking their family doctor or neurosurgeon about LSI they were told that we wouldn't be able to help because "the physician said that I have spinal stenosis brought on by bone spurs and the laser can't cut through bone."  However, these physicians are assuming that we only perform procedures that rely solely on lasers.  I am thankful that these prospective patients have taken the initiative to contact us to learn more about our techniques because the information they are receiving, while precise about instrumentation, is incorrect regarding LSI procedures.  Of course, the laser used in spinal surgery cannot cut through bone.  With laser, the energy required to vaporize bone would be very high. This amount of energy would generate too much heat, which would not be conducive to the area in which surgery is performed, i.e. the spinal cord and nerves. It is for this reason that we do not use laser on bone.

 Being a former back pain sufferer and as someone who was skeptical and anxious about undergoing surgery, I understand the need to have your concerns addressed.  However, the majority of physicians delivering this information to their patients about the Laser Spine Institute are unaware that our surgeons do have the instrumentation and the ability to remove bony material from the spinal canal, the foraminal canals, and the facet joint structures.  Our world class, professionally trained surgeons use a specialized tool called a rongeur, a strongly constructed instrument with sharp-edged, scoop-shaped tips used for carving out bone.   With this instrumentation, LSI has the advantage of being able to treat spinal stenosis, foraminal stenosis, bone spurs and facet arthritis, while still working through a series of dilating tubes and an incision less than one inch.  It's just one more way we can provide the most relief with such a minimally invasive approach.