Advanced spinal endoscopy is a minimally invasive technique that can treat pathologies such as herniated disc and canal stenosis with a simple approach that requires an incision of less than 1 cm in the skin.
This is a very innovative technique that involves the exploration of the spinal canal through a high definition optics that provides a light source. It consists of an endoscopic camera with a channeled optical system connected to a high-definition television screen, which allows visualizing the intervertebral disc and nerve roots with millimeter sharpness.
Depending on the vertebral level and the pathology to be treated, 3 approaches are used:
Advanced spinal endoscopy is a surgical technique that has not stopped evolving during the last 20 years, creating new methods and surgical approaches to approach the spine.
Phases of endoscopic spine surgery
The first phase, which requires approximately 30 minutes, consists of:
- Anesthetize the patient, in most cases of general type.
- Placing the patient accurately: prone position with cushions on the chest and pelvic region. Tilting in flexion of the lower extremities.
- Use of anteroposterior and lateral projections to identify exactly the approach and the entrance of the endoscopic optical camera.
- The recovery is very fast since the skin incision is only 1 cm and no drainage placement is necessary.
- Pain disappears immediately after surgery. Sometimes, if the nerves have been compressed for a long time or intensely, there is tingling (paresthesia) or cramping (hypoesthesia) that disappears in a few weeks progressively.
The patient is discharged the same day of surgery, once he has recovered from surgical anesthesia. The daily activity recovers during the first week and, in case of practicing sport, it is resumed from the sixth week.
The wound is so small that it does not require intensive care, it is simply kept clean and dry until the first revision (7-10 after surgery, where the first cure is performed and the stitch is removed).
In addition, it is essential to keep the muscles of the back and abdominals in good muscle tone. Some stretching exercises should be performed periodically to improve and / or strengthen dorsolumbar elasticity. It is also important to maintain good weight and healthy habits.
Advantages of Endoscopic Spine Surgery
To emphasize the advantages of advanced spinal endoscopy, it is necessary to compare this technique with microdissectomy and open surgery, which are also used for the treatment of lumbar disc herniation and canal stenosis.
- Minimal aggression of tissues
- Rapid recovery after surgery.
- High Definition Vision
- The incision in the skin is less than 1 centimeter.
- With minimal tissue aggression, postoperative pain is reduced and hospital discharge is almost immediately after surgery.
- It allows the treatment of pathologies in both the spinal canal and the foraminal-extraforaminal canal.
- Lower risk of degenerative complications and vertebral instability that may require more aggressive surgeries such as intersomatic arthrodesis (screws and bars).
- Less bleeding
- Less risk of infection
Lumbar disc herniation and canal stenosis are the pathologies that are best recovered with advanced spinal endoscopy. With the latter we can mill or drill all the structures of the bone that compress the exit of the nerves, both the laminae of the medullary canal and the foramen through which they exit.
Pre-endoscopic spine surgery
Before conducting an endoscopic spine surgery, it is essential to perform a previous study that should be composed of the following complementary tests: lateral, anteroposterior and functional radiographs at maximum extension and flexion of the lumbar spine; Magnetic resonance and neurophysiological study with electromioneurograma.
In addition, the patient must have maintained for at least 6 weeks symptoms resulting from lumbar disc herniation or canal stenosis, without significant relief with anti-inflammatories, analgesics or anti-neuritic drugs.
Sometimes, however, the symptoms are so intense that the patient can not withstand the pain and surgery is needed more precociously.
In relation to the post-surgical medication, anti-inflammatory drugs. Generally, with an analgesic drug is usually sufficient, but better complement in the report with two alternates if necessary. Muscle relaxants are only used in case of lumbar contracture.
Postoperative Endoscopic Spine Surgery
The surgical wound left by endoscopic spinal surgery is about 0.5 cms. In the back or lateral of the lumbar region. Usually a stitch or a staple.
From the fifth day we can perform wound washing, keeping it clean and dry with cures with betadine or chlorhexidine.
Due to its small size, there are usually no complications of infection or wound openings. Also, lumbar belt is not required, and after the first 15 days physical activity may increase.
From the first day it is advisable to perform movements of the dorsolumbar column without excessive energy: flexo-extension, lateralizations and rotations. During the first month should avoid bad postures or handling of heavy loads.
With the implantation of the stem cells in the damaged intervertebral disc, its clinical improvement and its prevention in the evolution of the spine are studied.
For more information consult a traumatologist .