Spine Department

Department of Spine Surgery Services

• Transforaminal Endoscopic Spine Surgery under Local Anaesthesia
• Transforaminal Endoscopic Decompression of Spinal Stenosis under Local Anaesthesia
• Interlaminar Full Endoscopic Spine Surgery
• PSLD – Percutaneous Stenoscopic Lumbar Decompression
• Endoscopic Foraminoplasty, Annuloplasty
• Endoscopic Interbody Fusion – E-TLIF, E-PLIF
• Percutaneous Spinal Instrumentation
• Percutaneous minimally invasive Intra discal Procedures

Transforaminal Full Endoscopic Spine Surgery

This Surgery is performed with a patient awake and aware in an operating room set up as a day care / overnight procedure. Surgery time is approximately 30-45 minutes per disc. A small 1/4 inch incision is made on the back to the side of the spine. The entry point is precisely calculated by fluoroscopic intraoperative measurements. Sedation and local anaesthesia are provided. The aesthetic will allow the patient to be comfortable  during the procedure  but will leave enough feeling in the nerves so the patient can actually tell when the nerve is being stimulated or when pressure is taken away from the nerve.

The instrument placement is performed under fluoroscopic  or x-ray guidance. A conical probe (obturator) with a side hole for palpating structures and for anaesthetising painful structures is used to dilate a path to the disc. After determining that the probe is in the safe triangular zone between the traversing and exiting spinal nerves, the disc is entered by bluntly fenestration the annular fibres with the probe in case of Intra discal pathologies. In case of extruded herniations, a targeted epidural approach is preferred using Hand drills & reamers enlarging the foramen and directly accessing the herniation.

If there is an unusual amount of pain with the docking of the blunt probe on the annulus, the surgeon can opt to visualise the outer aspect of the disc before entering the disc. Anomalous nerves and branches of spinal and autonomic nerves have been visualised and documented as contributing causes of back and leg pain that are currently not recognised by traditional surgeons. This area in the foraminal and extra-foraminal zone has been termed the hidden zone by surgeons Ian MacNab and John McCullough.

The presence of  these anomalous nerves and  the  ingrowth  of  nerves from  an inflammatory membrane that forms over the sensitive disc annulus is responsible for the pain that is out of proportion to what the MRI shows. This phenomenon is not yet completely understood, but good results have been obtained by identification and ablation of these nerves, and by elimination of the condition causing the inflammation.

The procedure proceeds by a cannula being passed over the blunt obturator followed by insertion of the endoscope and operating instruments. The two spinal nerves are protected by the cannula and only the part of the disc needing surgery will be exposed to the operating instruments. The endoscope  is  inserted  into  the  cannula and  degenerated  nucleus  pulpous  is  visualised and selectively removed from the herniation site in the posterior portion of the disc. When treating annular tears a small amount of nuclear tissue is removed from underneath the tear. Often, some of this nuclear tissue is seen interposed within the tear preventing it from healing.

The advanced endoscope has integrated multichannel irrigation channels allowing for continuous cool saline irrigation similar to knee arthroscopy.  A radio frequency electrode is used to help control bleeding, shrink the disc tissue or shrink the annulus, and ablate ingrown inflammatory/ granulation tissue. Heat from the radio frequency probe may also help depopulate and ablate the pain fibres in the annulus.

Advanced endoscopic techniques will also allow the experienced endoscopic spine surgeon the ability to routinely visualise the exiting nerve root, a nerve that is rarely visualised by traditional spine surgeons when they remove herniated discs. Lateral or foraminal stenosis contributing  to back pain& Leg pain can also be treated with this procedure. Overgrown bone and soft tissue compressing  the  Nerve in the  spinal canal & Foramen can  be  incrementally  removed  using advanced tools like Motorised Burr, Radiofrequency, Motorised shavers & Holmium YAG Laser.Decompression of the nerves can be confirmed & documented during the procedure. The procedure is performed in a setting where a single day hospitalisation is needed.

Why choose Endoscopic Spine Surgery

Advantages of Transforaminal Endoscopic Spine Surgery

• No Stitches and No Scar
• No General / Spinal Anaesthesia
• Minimal blood loss
• One Day Hospital Stay
• Safe & Effective
• Predictable outcome & Cost
• Minimum or no collateral damage to other structures i.e Muscle and tissue are dilated rather than being cut when accessing the disc.
• Return back to work much earlier than conventional spine surgery
• Almost all pathologies in Lumbar Spine can be treated