Benefits of Arthroscopic techniques in minimally invasive spine surgery

This type of minimally invasive surgery is performed on an outpatient basis using a local anesthetic. Since general anesthesia is not used, surgical risks are less. Arthroscopic surgery and use of endoscopic tubes minimizes muscle and other soft tissue damage. Patient benefits include less bleeding during surgery, reduced postoperative discomfort, fewer and smaller incisions, minimal scar tissue formation, and a speedier recovery. In addition, patients can avoid hospitalization and spinal fusion.

Arthroscopic Spine Procedures

Depending on the patient's diagnosis and surgical needs, sometimes more than one procedure is performed during a single surgery.

There are 4 primary arthroscopic spine procedures : -

1. Foraminotomy : - A foraminotomy helps to relieve symptoms caused by nerve root compression. The foramen are passageways between the vertebrae through which nerve roots exit the spinal canal. A foraminotomy may be performed to treat foraminal stenosis, bulging or herniated discs, pinched nerves, scar tissue formation, bone spurs (osteophytes), spinal arthritis, or sciatica.
   
   During a foraminotomy, the surgeon arthroscopically removes bone and tissue compressing the spinal nerve root. The endoscope is slowly removed to allow muscles and other soft tissues to move back into place. Occasionally, a stitch or two is needed to close the small incision.

2. Laminotomy : - A laminotomy is performed to increase the space around nerve roots and the spinal cord. The procedure helps to remove (decompress) pressure from these neural tissues. The lamina is the bony plate covering each vertebra's posterior arch, or entryway to the spinal canal and nerve structures.
   
   A laminotomy may also be performed to remove the ligamentum flavum. This is the spine's largest ligament. Sometimes the ligamentum flavum becomes thick and compresses the spinal cord contributing to spinal stenosis. When the surgeon removes part of the lamina, he can access the ligamentum flavum for removal.
   
   A laminectomy is similar to a laminotomy. The difference between the procedures is a laminectomy is usually performed during a traditional open back surgery to remove the entire lamina. A laminotomy does not remove the entire lamina, but only a portion of the bony plate
   
   A laminotomy is performed to treat bone spurs (osteophytes), bulging and herniated discs, pinched nerves, scar tissue, spinal arthritis, and spinal stenosis.

3. Percutaneous Arthroscopic Discectomy : - Percutaneous means through the skin. A percutaneous arthroscopic discectomy is the surgical removal of bulging or herniated disc material. Bulging and herniated discs are a common cause of nerve root and spinal cord compression.
   
   During this minimally invasive procedure, the surgeon uses a laser to vaporize disc material to reduce pressure on the spinal cord and nerve roots. When the procedure is completed, the endoscopic tube is slowly removed to allow muscles and soft tissues to move back into place. A percutaneous arthroscopic discectomy is a short procedure only taking 30 to 45 minutes.

4. Facet Thermal Ablation : - A facet thermal ablation is performed to treat facet disease, facet joint syndrome, facet hypertrophy (enlargement), facet arthritis, or facet joints affected by degeneration. The facet joints are the spine's joints. Found at the back of the spine, 2 vertebrae share 1 facet joint.
   
   Thermal ablation refers to disabling or destroying a nerve using a laser. During the procedure, the surgeon uses a laser to clean the facet joint and deaden the nerve that innervates the joint and causes pain.
   
   After a local anesthetic is administered, a small incision is made and the endoscope is inserted. The endoscope (about the size of a straw) helps protect surrounding anatomical structures from damage during thermal ablation. The procedure only takes about 40-minutes.

Laser Spine Surgery : -

The most commonly performed spinal operation in the United States is the lumbar discectomy. Lumbar discectomy is the cornerstone of surgical treatment of disc herniations. A disc herniation is a protrusion of the inner core of disc material beyond the confines of the disc space to compress on the lumbar nerve root(s). This nerve root compression causes a variety of symptoms, but most notable is that of sciatica. Sciatica is a radiating pain from the low back around the hip joint into the leg and down the leg to the foot. Fortunately, 80% of symptomatic disc herniations respond to non-surgical treatment. For the remaining 20%, lumbar discectomy is the treatment of choice 

How long does surgery typically last?

The average spine procedure lasts about an hour. When the procedure is complete, the surgeon removes the tube to let the tissue and muscle go back to their natural position. The last tube is gently removed and absorbable sutures are used to close the incision. The patient is wheeled into the post-anesthesia care area where their vital signs are monitored, medications are given as needed and some light refreshments can be enjoyed. That same day, patients are encouraged to walk around. Soon after, they are discharged home or to their hotel.

What's the recovery process like?

After a day of rest and recovery, the patient returns for a postoperative appointment. An epidural injection may be given to reduce swelling and increase range of motion. Physical therapy may be prescribed. Physical therapy consists of a series of stretching exercises, walking, ice or heat, gentle electronic stimulation and a nice relaxing massage. Each patient is given instructions for postoperative activity and limitations. Over the weeks and months to come, gradual and continuous improvement will be seen, as the nerves and tissues heal. With time and exercise, the body can repair any damage, gain strength, and a gradual increase in daily activities can occur.