Frequently Asked Questions
What is endoscopic spine surgery?
Endoscopic spine surgery is a minimally invasive spine procedure. The incision is less than 10 mm and the muscle is split with dull dilators. During the surgery, surgeons place small tubes onto the diseased area in the spine using modern percutaneous techniques; they utilize needles, guidance wires and dilators under precision x-ray guidance (fluoroscopy). The tubes range from 4 mm to 8 mm in diameter. The smaller ones are used in the cervical and thoracic spine and the larger ones are used in the lumbar spine. The tubes function as tunnels for the endoscope, a tool that provides channels for light, irrigation and micro instruments such as lasers and graspers.
What are the advantages and disadvantages of the endoscopic spine surgery?
Endoscopic spine surgery is as effective as open spinal surgery for many spinal diseases but the advantages of endoscopic spine surgery are tremendous. Endoscopic spine surgery:
- Preserves spinal motion by avoiding unnecessary fusion.
- Takes days and weeks to make a recovery, rather than the months or years taken by open spinal surgery. It is a same day surgery and the ambulation starts right after the surgery in the recovery room.
- Is generally done under local and sedative anesthesia, so avoids the risks of general anesthesia.
- Causes minimal bleeding, if any at all.
- Have a few than 3% occurrences of complications such as wound infection, spinal infection, spinal cord membrane (dura) tears, nerve injuries, making it many times less risky as open spinal surgery. Additionally, no mortality (death of patients) has been reported worldwide related to endoscopic spinal surgeries.
Unfortunately, the learning curve for endoscopic spine surgery is very steep. Surgeons are required to have special training, experiences, good hand skills and passion for these breakthrough techniques.
What is laser?
Laser is short for light amplification by stimulated emission of radiation. Basically it is light energy. During the surgery, the laser beam is directed to the surgical area. It ablates and shrinks tissues; and it coagulates bleeding and removes bone spurs, herniated discs and scar tissue surrounding spinal nerves precisely and safely. The most commonly used laser for spinal surgery is Holmium-YAG laser, with a specific wave-length. In general, the depth of cutting for Holmium-YAG laser is 0.4 mm for soft tissue and 0.2 mm for bone.
Who will need endoscopic spine surgery?
Endoscopic spine surgery is revolutionary in pain management and spinal surgery. Patients with neck pain, limb pain and back pain are indicated for surgery if they are not better after 6 weeks of conservative treatments. Patients with lumbar spinal disc herniations, regardless to their sizes and locations, can be effectively treated with endoscopic spine surgery. Furthermore, the application of the technique is not limited to disc herniations. Spinal stenosis, bone spurs, slipped vertebrates, and spinal joint arthritis can be effectively treated as well. Endoscopic spine surgery is also applicable to patients whose traditional spinal surgeries have failed. In the past, these patients were usually dependent on narcotic pain medications, creating misery and decreasing quality of life. With endoscopic spine surgeries, patients are likely to have significant pain relief and avoid or reduce their use of narcotic pain medications, allowing them optimal function and a much improved quality of life.
What is the recovery time for endoscopic spine surgery?
The recovery from endoscopic spine surgery depends on the physical condition of the individual, the extent of the disease and the complexity of the surgery. For simple lumbar disc herniation, the recovery is a few days. For patients with extensive pathology with bone spurs, scar tissue in multiple levels of spine and slipped vertebrates, the full recovery will take a few weeks. However, most patients return to light duty work in 2-3 weeks and full duty in 6 weeks. After surgery, the physical therapy with soft tissue modalities and muscle balance exercises are required.
What is back sprain and strain?
Back sprain and strain occurs when tissues in the lumbar spine are over-stretched or torn. This is the most common but less severe cause of back pain. Strain applies to injury of ligaments while sprain applies to muscle injury. Back sprain and strain are called musculoligamentous injuries. Clinically, these injuries are associated with muscle spasms and reduction in lumbar spine mobility. Patients feel acute and chronic pain or soreness in the lower back. The pain is aggravated by most physical activities like standing, bending and walking. Normally these injuries are not accompanied by leg pain.
What is disc tear, disc bulge, disc degeneration, and disc herniation?
The human spine is made up of 33 bones, called vertebra. These vertebrae are connected by spinal discs, facet joints and ligaments. Spine problems cause pain, including but not limited to neck and back pain and sometimes leg and arm pain.
Spinal discs connect vertebrae together. A spinal disc is made up of a spongy, jelly-like nucleus and twenty layers of fibrotic tissue (annulus) that surround the nucleus. Healthy spinal disc nuclei are rich in water, functioning as shock absorbers.
A spinal disc degenerates through wear and tear. First, the jelly nucleus loses water and becomes dry, taking away its shock absorbing function. Then physical loads can make the annular tissue bulge out (disc bulging). As the tissue overstretches, it tears or cracks. These tears allow the jelly nucleus to leak out from its normal position (disc herniation).
Clinically, disc herniation patients feel lower back pain and leg pain, which worsens with sitting but may improve with standing.
What are neuritis, radilulitis, radiculopathy, sciatica and cauda equina?
Spinal disc degeneration, disc tear, disc bulge, disc herniation, bone spurs, bone slippages, spinal facet diseases, and spinal stenosis are common causes of lower back and leg pain. In these conditions, natural inflammatory chemicals irritate surrounding nerve tissues or spinal nerves.
Spinal nerves are also injured by mechanical compression due to disc herniation, spinal stenosis or other causes (radiculopathy). Patients with radiculitis and radiculopathy feel numbness, pins and needles, and weakness in the legs and feet. In severe cases, patients feel their legs becoming smaller, muscle atrophy and foot drops.
Two lower lumbar spinal nerves (L4 to L5) and the first sacral nerve (S1) unite together to form a big trunk of nerves traveling down the leg to the foot (sciatic nerve). Compression of the sciatic nerve causes leg pain and is called sciatica.
Some spinal nerve compressions cause loss of bowel and bladder control, or control of gait and balance (cauda equina sndrome). These cases require emergency surgical decompression.
What is failed back surgery syndrome (FBSS)?
Back spine surgery is a very common procedure for treatment of lower back pain. Surgical operations typically are for spinal decompression and spinal fusions using cages, bone grafts, bars and screws. After a surgical operation, if a patient continues to have symptoms of back and leg pain, it is called failed back surgery syndrome. Unfortunately, the pain is much worse than prior to surgery. Patients with FBSS are heavily medicated, disabled from work and isolated from society.
FBSS occurs in 20-40% of open spine surgeries. The most common cause is adjacent lumbar segment disease, non-fusion status, segmental instability, and scar formation in the spinal canal with spinal nerve compression.
What are the risks of Endoscopic Spinal Surgery?
Like any other surgery, endoscopic spinal surgery carries risks. However, these risks are very rare. They include, but not limited to, infections, bleeding, nerve and spinal cord injuries, and failure to relieve pain.
How long do I have to stay in your area if I come from out of town?
You will need to stay for 3-4 days. Since this is an outpatient surgery, you'll need to book a hotel in the area. We have negotiated discounted rates with some of the hotels located near our Edison and Union surgical centers. The first day of your stay is for preoperative visit and testing, the second day is for surgery and third and/or fourth day for a postoperative follow-up visit.
After cervical surgery, how long should I wear a neck collar?
For cervical surgery patients, a neck collar should be worn for one week. It can be taken off during sleep and when taking a shower.
Will I need someone with me during my trip?
You will need somebody to accompany you on the day and night of surgery. You’ll also need someone to drive you to your destination/hotel for your surgery. Transportation from the hotels to our surgical center is available when requested in advance.
If endoscopic spinal surgery is state-of-the-art, why don’t more surgeons perform this type of procedure?
The procedure is getting more and more popular. When the time comes, it will be a standard technique, just like laparoscopic removal of the gall bladder and arthroscopic knee and shoulder surgery. However, endoscopic spine surgery is still in its infancy. Most of the medical residents in orthopedic spine surgery and neurosurgery graduated without having been exposed to this technique. Furthermore, the learning curve of endoscopic spinal surgery is very steep. To be very good, a surgeon needs intensive training and repeated practice but most importantly, passion, skills and intelligence.
Even with extensive training, the real difference is our experience. In order to master the minimally invasive techniques, the more experience a surgeon has, the better. We are dedicated solely to spinal care, with many years of experience and thousands of satisfied patients.
Other surgeons claim to perform minimally invasive surgery. How does ASC’s technique differ from theirs?
We perform true minimally invasive spinal surgeries. Some surgeons may refer to a surgery as “minimally invasive” simply because they make a small incision. However, retractors are still used which causes ripping and tearing of the muscle, resulting in pain, blood loss and a long recovery. Our endoscopic surgical techniques allow us to go between the muscle with no need for cutting at all.
Are these surgical procedures considered experimental?
Microdiscectomy is a standard surgical procedure for the treatment of lumbar disc herniations. However in order to improve the surgical outcomes and reduce surgical complications, research or experiments on microdiscectomy have never stopped. Recent studies have compared endoscopic lumbar discectomy with microdiscectomy. The studies showed that long term (2 years) outcomes after endoscopic lumbar discectomy and microdiscectomy are not markedly different, and that endoscopic surgery has advantages such as faster recovery and less postoperative pain.
Is my bulging disc or herniation going to be removed?
Yes, if the herniated or bulging disc is symptomatic and does not respond to conservative treatment.
Should I come back to ASC (Atlantic Spine Center) for my follow-up visit if I live in another state?
Follow-up visit with us is always encouraged if it is possible. We follow our patients over the phone for a week after surgery. We are very accessible to all patients.
What if your surgical techniques are unable to help my condition?
Atlantic Spine Center has built a reputation of being a company that listens to and cares for our patients. In our fight to help people get rid of their pain, we have spent years building what we feel is one of the strongest patient referral programs in the US. What this means to you is that if we feel we cannot help you we will point you in the direction of those who we believe can. This is one of the main reasons we have one of the highest patient satisfaction reputations around.