Background/purpose: Operating under local anesthesia allows the patient to respond and provide feedback during surgery that is invaluable for patient safety and for the assessment of the pain generators and ultimately understanding of the source of pain that the surgeon is targeting. Over 10,000 case studies make up the database for information gleaned from patients reporting the pain experienced and relieved during translaminar and transforaminal endoscopic decompression.
Method: The patient is provided mild sedation with versed and fentanyl unless no sedation is requested. Patients requesting no sedation are usually anesthesiologists and other spine surgeons who opt for decompressive surgery, but wanted some measure of surgical participation and control. The anesthesiologist titrates the patient with 1-2 cc of fentanyl and versed pre-op with titration during surgery. The average total amount is 4-5 cc for most procedures. 1% lidocaine is utilized for the local anesthetic. An average of 10-20 cc is used for local anesthesia, titrated as needed during surgery.
Results: The results of decompression can be predicted by a combination of pain relief reported during, immediately after, and augmented by visualization of the targeted patho-anatomy. Such visualized pathology visualized includes annular tears, decompressed spinal nerves, and visualization of the axilla between the traversing and exiting nerve.
Conclusion: Observations provides level 5 EBM (Expert opinion) for surgical intervention. Evidence based medicine usually starts with level 5 “expert” opinions. With the ability to evoke pain in conscious surgical patients, with endoscopic images of the patho-anatomy that correlates evoked pain production with subsequent pain resolution following visualized endoscopic decompression. Along with comparison of pre-and post op images, a new and different and level of EBM may emerge and need to be considered in addition to the traditional Levels 1-5 EBM guidelines.
Introduction: Endoscopic spine surgery has attracted both surgeons and nonsurgeons in increasing numbers as endoscopic spine systems, a variety of spine endoscopes, and new and evolving surgical instrumentation are developed. The procedure, using fluoroscopically guided percutaneous techniques, are getting more standard, easier, safer, readily reproducible, and more cost effective. It has also been an avenue for surgeons and a few appropriately trained and certified non-surgeons to participate in a minimally invasive, procedure oriented health care delivery platform that provides cost effective results after failure of nonsurgical methods. Such a multidisciplinary team has been established at the University of New Mexico through a donation to the University by the first author.
Discussion: Asia, especially China and Korea, has seen adoption of endoscopic spine surgery grow exponentially in the past few years, recognizing that endoscopic spine surgery may be the answer to delivering cost effective spine care to their working and aging population. Two basic methods are the mainstay of current endoscopic techniques. The least invasive techniques in the lumbar spine are transforaminal, but translaminar endoscopic approaches are better accepted and easier for endoscopic surgeons to grasp.
Conclusion: Endoscopic spine surgery has great promise in countries with looking for cost effective delivery of health care to its population. Endoscopic surgery is the least minimally invasive surgical platform that will facilitate a move away from fusion as a first line of surgical treatment, delaying or eliminating fusion for patients who may have indications for decompression and fusion, but do well with an earlier and staged procedure that will mitigate the need for open decompression and fusion by 75%, derived by large individual and group databases known to this author.
I have NEVER received such a professional, friendly, thorough physician visit! The proposed procedure was discussed in such a manner as to instill me with confidence that I had found the right surgeon and an office beyond all my expectations!
Surgeon: Dr. Justin Field of Desert Institute for Spine Care, Phoenix, AZ
Indications: Bulging discs
Procedure: ALIF Levels Treated: L4-S1 Surgery Date: August 31, 2011
Life Prior to Surgery: Five years ago, Monica injured her back during an on-the-job accident in the emergency room when a patient fell on her. She decided to try physical therapy as treatment for her pain which provided relief until recently. On August 1, 2011, Monica twisted the wrong way while at work filling out patient paperwork and felt a “pop” in her back. She immediately experienced intense pain which she tried to “walk off”, but it only worsened. She checked into the emergency department and an MRI revealed bulging discs at L4, L5, and S1. In addition, the discs were impinging on her sciatic nerve. She saw her primary care physician who filled out the workman’s comp information and referred Monica to Dr. Justin Field.
I just wanted to extend many thanks to you for your services with my wife’s spinal surgery. It was a very difficult period in our lives with her back health, and we made the decision to see Dr. Field. From the very beginning, to the care and kindness of the staff, the surgery, and post-op care, we were just so thankful and satisfied with everything.
Today, she has fully recovered and finished her schooling, working as a Sterile Processing Instrument Tech. She is able to work, exercise, and do family activities just like before. Dr. Field is the best!
A big thanks to all of you! Mike and Kellie Gordley
For the first time in 4 years I can honestly say that I am pain free!!! What started out as a furious series of back spasms that I experienced every 3-6 months developed over time into sciatic nerve pain. Not only did this recurring nightmare take its toll on my health and well-being, it also created a downward spiral for my social and professional endeavors.
Over the past few years, I’ve anxiously searched for answers to figure out what the cause was and to discover a cure. I started out with massage and chiropractic care. Then I tried other remedies like acupuncture, cortisone shots and physical therapy. Finally, I got my first MRI and we discovered that I had 2 herniated discs L4/L5 and one extremely bulged disc L5.
In November 2009 I herniated my C5/C6 and C6/C7. I saw another surgeon in the east valley whom performed surgery, which put me in more pain and then a second surgery that got me back to where I was when I initially herniated the disc. I had consulted 3 other doctors, all of which told me that I’d never be the same again and would have the chronic pain for the rest of my life. At that point all hope of living a normal life was lost and getting used to my new life with an obsessive amount of medication was sending me into a deep depression, especially for a 34 year old husband and father of 2 young boys.
Lorraine Polinsky Clark and her husband, Steve, moved to Sun City Grand from Chicago three years ago to spend their early retirement years living an active lifestyle. As competitive level ballroom dancers with professional training in Chicago from a world champion, they were drawn to the Valley’s popular ballroom community and enjoyed dancing regularly during the first year living here.
Then one day, out of the blue, it was like a light switch went on and Lorraine was suddenly in severe pain. “Immediately, I was in excruciating pain from my waist all the way down to my heel,” she said. “It was the worst, most debilitating pain and literally came out of nowhere.”