1. What is endoscopic spine surgery?
Endoscopic spine surgery is a minimally invasive procedure performed using anendoscope. When performing endoscopic surgery, the surgeon inserts a guidewire through a small incision, i.e. a metal tube with a diameter of 8 mm, whichallows accessing the site of the spinal canal narrowing. The surgery is carried outusing miniature surgical instruments. Fragments responsible for pressure on thenerves are removed with micro scissors, bone rongeurs and diamond drills.Diamond drills allow cutting bones without risking damage to nerve structures.They slide over them, but are unable to damage them.
2. What are the advantages and disadvantages of endoscopic surgery?
Endoscopic spine surgery is just as effective as open surgery, but the benefits of endoscopic surgery are incomparable.
When using the endoscopic method:
– The spine mobility is preserved, avoiding unnecessary fusion.
– Bleeding is minimal, if any. The scar after incision one of a few millimetres.
– There are less than 3% of complications, such as wound infection, spinal infection, nerve injuries, etc., which makes endoscopic surgery far less risky than open spine surgery. In addition, no mortality associated with endoscopic spine surgery has been reported anywhere in the world.
– Recovery takes several weeks, not months, which is the case with open spine surgery.
Hospital stay is 24 hours. Surgeons who perform endoscopic spine surgery must have special training, experience, skills and a passion for using modern techniques.
3. Who needs endoscopic surgery?
Endoscopic spine surgery is a revolutionary method of both treatment pain and spine surgery. The procedure is suitable for patients with neck/nape pain, limb pain and back pain, in which conservative treatment failed. Patients with lumbar spinal hernia can be operated, regardless of their size and location. The treatment is effective at stenosis, i.e. narrowing of the spinal canal, spondylolisthesis and many other diseases. Endoscopic spine surgery is also recommended for patients whose traditional spine surgery has failed. In the past, these patients were usually addicted to narcotic analgesics, which further reduce the quality of life. In the case of endoscopic spine surgery, patients experience significant pain relief, and the use of narcotic analgesics is not necessary, which allows them to function optimally and significantly improves the quality of their life.
4. How soon do you recover after endoscopic surgery?
Recovery after endoscopic surgery of the spine depends on the patient’s physical condition, the extent and duration of the disease, and the complexity of the surgery. In the case of, for example, a hernia in the lumbar spine, recovery usually takes several days. In other cases it’s up to 6 weeks. Most patients return to light work within 2-3 weeks, and to full activity within 6 weeks. After surgery, physiotherapy is required.
5. What is a spinal hernia?
The intervertebral disc consists of a peripheral part called the fibrous ring and a central part which is the nucleus pulposus. Under the influence of many years of loads, incorrect posture, bad habits, lazy lifestyle (including sitting work), the intervertebral disc may cease to fulfil its functions properly. The fibrous ring is unable to hold the nucleus pulposus within its boundaries, which leads to its bulging, causing pain. This can apply to any height of the spine, but most often there occurs discopathy of the spine in the lumbar and cervical spine.
6. Is there a difference between a hernia in the lumbar part and a hernia in the cervical spine?
The only difference between the lumbar hernia and the cervical hernia is that the former causes pain in the neck, arms, numbness of the hands, while the latter manifests itself in pain in the lower back, often radiating to the buttocks, legs and feet.
7. The doctor has diagnosed a hernia. What's next?
The goal of hernia treatment is to heal the damage, and prevent it from bulging in the future.
Treatment usually begins with administration of medicine to help relieve swelling or inflammation in the damaged area. The use of physiotherapy and exercise helps to develop muscles that provide support to the spine.
However, sometimes conservative, non-surgical treatment fails. At this point, surgical treatment for a hernia should be considered to improve the quality of the patient’s life.
In modern surgery, endoscopic discectomy is used – a surgical procedure used to remove the damaged fragment that causes pain. It is a modern technique that does not require bone removal, muscle damage or large skin cuts. After endoscopic surgery, a 24-hour hospital stay and short rehabilitation, patients return to normal activity very quickly, and enjoy life again.
8. What is stenosis?
When the first symptoms of spinal canal stenosis appear, patients often blame them on the age. Because the conviction is that after 60 years of age the spine has the right to hurt. Osteoarthritis is tricky. Initially, the pain appears rarely, and lasts a short time. Over time, the proportions change. The spine hurts longer, and the periods when the patient can function normally are getting shorter. Over time, it hurts continuously all the time. However, when the pain becomes unbearable, suffering people begin to seek help. Usually, however, they receive more painkillers or a proposition of surgery, it being made clear that this is a risky, complicated procedure. However, stenosis can be cured in a minimally invasive way, without the risk inherent in traditional surgery. Stenosis is a narrowing of the spinal canal that causes compression of the nerve structures. The narrowing is usually the result of progressive degenerative lesions of the spine. They occur due to the weakening of the muscles stabilizing the spine, which appear with age. Stenosis is manifested by pain in the spine radiating towards the legs, thighs or buttocks. Nerve roots run through the spinal canal, which in the lumbar region should flow loosely in the cerebrospinal fluid. In a situation where there occurs a narrowing of the canal, the roots are blocked, and any attempt to move them, e.g. while walking, causes pain.
9. What is the difference between endoscopic stenosis and traditional surgery?
Traditional surgery of stenosis consists in removing a fragment of the rear of the spine that is affected by degenerative lesions. An open spine procedure with a few or even a dozen or so centimetre incisions on the back requires not only cutting the skin, but also sheeting out of the spinal muscles. After such extensive removal of hypertrophied facet joint capsules, instability of the operated spine fragment often occurs. The use of implants is then necessary. The extent of this type of surgery means that it’s going to take a long time for the patient to become fit again. Postoperative scar healing alone often takes several weeks. Such a large incision in a place that is constantly exposed to movement is also a high risk of infection. This is coupled by rehabilitation lasting several months.
For endoscopic surgery, a minimal incision of a few millimetres is applied, and most importantly, no implants are needed. During the procedure, in order to widen the spinal canal, only the excess yellow ligament and part of the joint are removed, i.e. only those elements that are responsible for narrowing, and thus pain. It is a much less invasive surgery than the traditional one. Postoperative pain using the endoscopic method is reduced to approximately 90% compared to conventional surgery.
10. When is stenosis surgery necessary?
Reasonable exercises tailored to the needs and health of the patient, and performed under the care of a specialist physiotherapist can help. If there is no improvement or, on the contrary, the pain increases so that it no longer allows normal functioning, then surgery is necessary. Walking problems become unbearable, and the distance that the patient can overcome by himself or herself is shortened. At the initial stage of illness, the elderly have a problem with, e.g. reaching the store, and later on they stop walking up the stairs. They usually explain their ailments by age. With time, however, they stop leaving the house because they are unable to walk even several dozen meters. Endoscopic surgery can change their lives very much.
11. What is the risk of endoscopic surgery?
Like any other surgery, endoscopic spine surgery carries risks. However, these threats are very rare. These include, among others, infections, bleeding, nerve and spinal cord injuries, and failure to relieve pain.
12. How long do I have to wait for the procedure?
The waiting time is usually 2-3 weeks.
13. How long will I stay in the hospital?
Hospital stay usually takes 24 hours. Postoperative consultation within 4 weeks of surgery.
14. Test results that I need to take with me?
It is important to have imaging results (a CD with magnetic resonance imaging or CT scan). If the patient has a confirmed blood type, they should take the document. All laboratory tests will be carried out on the spot.
15. If the endoscopic method is so effective, why not all surgeons use it?
For the patient, endoscopic surgery has only benefits. Its disadvantage is the learning curve. A neurosurgeon who wants to undertake an endoscopic surgery needs many years of education in this field, as well as many performed procedures and experience. Not every good doctor is able to perform endoscopic surgery of the spine.