Recurrent pain is anticipated and treatable especially if the initial index surgery is successful. Recurrence is as simple as a recurrent herniated disc that can occur within days or years, or an annular tear that fails to heal after many episodes where the tear heals naturally.
However, with the aging process, patients will all have painful conditions that arise just from the aging process. It is always desirable to let nature take its course by managing the pain using natural means or common sense, but because endoscopic decompression, ablation, and irrigation will safely and efficiently treat these conditions of aging, We only have to know how to perform diagnostic and therapeutic injections to obtain a prognosis for endoscopic transforaminal surgery in experienced surgeons hands.
These videos will illustrate how patient selection with previous successful surgery and identification of their pain generators with diagnostic and therapeutic injection will provide the prognosis for a good result with foraminal endoscopic surgery.
Post-op recurrent sciatica can occur as a natural progression of the natural ageing process. Osteophyte Disc Complex is one of many legitimate conditions following a good surgical result, but resulting from the ageing process.
When the patient has a Workers’Compensation injury, all requests for surgical intervention are reviewed by an Independent Medical Examination (IME) Physician. IMEs are becoming less independent and more biased in their opinions based on paid opinions more favorable to the payor. Because of this, over 50% of IMEs in Arizona are litigated.
This video is of a patient who is a police officer who was injured with a herniated disc 12 years previously on the job. He had to battle his insurance carrier to get his initial surgery for a herniated disc. He worked with his herniated disc, but eventually required transformanial endoscopic surgery. He returned to work pain free for the next few years, but had a recurrence of his sciatica from a Osetophyte Disc Complex due the progression of the aging process.
The IME physician denied the surgery, causing the officer’s union to pay for a lawyer to force the carrier to allow him to have his surgery. This is becoming a common problem with workman’s comp authorizations.
Post-op stenosis responds will to foraminal endoscopic decompression. It is very minimally invasive and effective if transforaminal epidural steroid injections help. This All American Basketball player from Michigan, who is also a physician still working at his age, had pain that was relieved by a transforaminal epidural steroid injection at the suspected level(s), but worse pain was at L5-S1. He had a previous successful surgery by Robert Watkins, the spine surgeon know for operating on professional athletes. This athlete elected to undergo endoscopic decompression for his pain.
This 78 year old All-American Basketball player and physician (M. Burton, MD, OBGYN) had endoscopic decompression and ablation surgery for residual symptoms of his aging spine. He received successful multi-level stenosis decompression of the L5-S1 from Dr. Robert Watkins over 10 years previously (reference video: Post-op Stenosis Effective with Transforaminal Decompression).
The patient came back requesting decompression of the L2-3. The patient was awake and his response during decompression helped guide the extent of decompression needed. Even after successful translaminar decompression, lateral stenosis progresses is an aging spine.