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.
Dr. Nima Salari with DISC performed Hemilaminectomy with decompression on my L-1 through L-5 on Oct. 23, 2017. I cannot praise Dr. Salari highly enough for improving the quality of my life.
I have had four major surgeries in as many years, but the entire process from beginning to post-op care with DISC and Dr. Salari was exceptional. From the front office people to the successful surgery and post-op care, all was done professionally with attention and care for the patient upper-most in their minds.
Anyone contemplating back surgery should contact Dr. Salari before making a decision as to whom you would like to have perform surgery on your back.
I give Dr. Salari with DISC the highest rating possible.
Two Micro-discectomies by Dr. Anthony Yeung; Lumbar surgery by Dr. Salari
After I herniated my disc, at work – I had sciatic leg and lower back pain. Dr. Anthony Yeung, performed 2 separate micro-discectomies, both were successful. I had a very active field job in Telecommunications and worked climbing towers, and carrying communications equipment and pulling cable. I also went to the gym 5-6 days a week.
My 3rd and most likely, last lumbar surgery was performed by Dr. Salari. This was the most difficult as some bone had to be cut away for Dr. Salari to be able to access the area that would relieve the pressure on the nerves causing me pain.
As a 77 year old school bus driver, part of my job requires that I routinely perform pre-trip systems checks to ensure that everything is working properly. One Friday morning, I was inspecting the clearance lights because we begin work while it’s still dark outside. A single light in the back of the bus was being temperamental, so I began walking towards it down the empty parking lane beside me. I was looking up at the lights, not watching where I was stepping, and suddenly tripped and hit my head on the bus next to me. I got a large gash on my head that hurt terribly. I went to clean it up and get ready to leave when I noticed pain shooting down both my arms. I began flailing my arms to try to stop the intense pain.