Commonly Asked Questions.
What is endoscopic laser spine surgery?
Endoscopic laser spine surgery is a minimally invasive spine procedure. The skin is generally cut less than 10 mm and the muscle is split with dull dilators. During the surgery, surgeons place small tubes on to 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 diameters. 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 laser spine surgery?
Endoscopic laser spine surgery is as effective as open spinal surgery for many spinal diseases but the advantages of endoscopic laser spine surgery are tremendous. Endoscopic laser 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 occurrences of complications such as wound infection, spinal infection, spinal cord membrane (dura) tears, nerve injuries, and other injuries fewer than three percent of the time, making it many times less risky as open spinal surgery. Additionally, no mortality (death of patients) has been reported worldwide related to endoscopic laser spinal surgeries.
Unfortunately, the learning curve for endoscopic spine surgery is very deep. The surgeons are required to have special training, experiences, good hand skills, and passion for these cutting edge techniques.
What is laser?
The 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, osteophytes, 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 laser spine surgery?
The endoscopic laser 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 the endoscopic laser spine surgeries. 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 laser spine surgery is also applicable to patients who failed to traditional spinal surgeries. In the past, these patients were usually dependent on narcotic pain medications, creating misery and decreasing quality of life. With endoscopic laser spine surgeries, patients are likely to have significant pain relief and avoid or reduce use of narcotic pain medications, allowing them better function and quality of life.
What is the recovery time for endoscopic laser spine surgery?
The recovery from endoscopic spine surgery depends on physical condition of individuals, extent of the diseases, 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. 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, radiculitis, 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, inflammatory chemicals irritate surrounding nerve tissues or spinal nerves (neuritis and radiculitis).
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 nerve travelling 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 syndrome). These cases require emergency surgical decompression.
What is lumbar facet joint disease?
The facet joints are part of the connection between vertebrae. When spine wears and tears, the spinal discs become thinner, placing more of the burden of support onto the facet joints. The increased stress causes inflammation and growth of bone spurs. Clinically, patients feel lower back pain, buttock pain, and upper leg pain. The pain usually worsens when bending backwards and to the side.
What are spinal stenosis and foraminal stenosis?
Stenosis means narrowing in medicine. Spinal stenosis is the narrowing of spinal canal and foraminal stenosis is the narrowing of spinal nerve holes (foramen). The most common cause of spinal stenosis is wear and tear or denegation of spine. Stenosis starts with spinal disc changes, such as tearing, bulging, scarring, herniating, and narrowing. Gradually, the spinal facet joint becomes inflamed. The ligaments in spinal canal and nerve holes become overgrown. Bone spurs form on the vertebra and facets. These new growths compress spinal cord and spinal nerves.
Clinically, lower back pain and leg pain from spinal stenosis is very common. The pain usually worsens when standing and walking. Sitting or taking a break from walking helps. The patient sometimes feels weakness, numbness, tingling in the legs and feet because of nerve pinching or neuritis.
Spinal stenosis commonly occurs in the elderly, who exhibit shopping cart syndrome, so called because sufferers prefer to lean on their shopping carts rather than suffer the pain of standing upright.
What is spondylolisthesis?
Spondylolisthesis is a medical term for spine slippage. The human spine is beautifully aligned in an S shape. The maintenance of this alignment depends on the strength of connecting ligaments and integrity of vertebral bones. Spinal degeneration weakens the strength of ligaments, resulting in spine slippage. This type of spine slippage is called degenerative spondylolisthesis in medicine. It mostly occurs in people over 60 years old.
Spine slippage also occurs in the young and middle aged. These cases are mostly related to a fracture or fractures in vertebral arch due to injury or poor blood supply (ischemic). This type of slippage is called ischemic spondylolisthesis in medicine.
Spine slippage causes distortion of spinal cord and nerve. Clinically, the back and leg pain experienced is similar to experiences from those with spinal stenosis described above.
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 graft, 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 Foraminal stenosis. Other causes include: Recurrent herniation or stenosis, adjacent lumbar segment disease, non-fusion status, segmental instability, and scar formation in spinal canal with spinal nerve compression.
What are the risks of Endoscopic Laser Spinal Surgery?
Like any other surgery, endoscopic laser spinal surgery carries risks. However, these risks are very rare. They include, but are not limited to, infection, bleeding, nerve and spinal cord injuries, and failure to relieve pain, worsening pain, and the need for further surgeries.?
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. There are many hotels/motels to choose from in the Bay Area.
The first day of your stay is for preoperative visit and evaluation by Dr. Naraghi for him to review your actual MRI pictures, and make further recommendations. The second day is for surgery. The third and/or fourth day for a postoperative follow-up visit.?
After cervical endoscopic surgery, how long should I wear a neck collar?
A neck collar should be worn for one week, after endoscopic surgery. 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 laser spinal surgery is state-of-the-art, how come not so many 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 gall bladder and arthroscopic knee and shoulder surgery. However, the technique is still in its infancy. Most of the 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 not only adequate training and repeated practices but also passion, skills, and intelligence.
Are these surgical procedures considered experimental?
"Experimental" is a relative term. 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 herniated or bulging disc is symptomatic and does not respond to conservative treatment.
Follow-up visit with us is always encouraged if it is possible. For patients from out of town we can follow our patients over the phone for a week after surgery. We are very accessible to all patients.