This blog is excerpted from an article by Alan Condon on January 31, 2020 on Becker’s Spine Review and a study by Anthony Yeung, MD & Kai-Uwe Lewandrowski, MD published January 2020 in the Journal of Spine Surgery.
Endoscopic spine surgery has the potential to become the leading minimally invasive surgical technique for the treatment of common degenerative conditions of the spine.
Anthony Yeung, MD, of the Desert Institute of Spine Care in Phoenix, and Kai-Uwe Lewandrowski, MD, of the Center for Advanced Spine Care of Southern Arizona in Tucson, examined the early management of spinal diseases and whether early intervention can reduce long-term disability associated with them.
The authors argue that spinal endoscopy could help eradicate the repetition of less cost-effective procedures currently available in spine and that the staged management approach ultimately reduces disability, utilization and cost.
“We’re doing procedures earlier in the disease process to intervene early and give the body the ability to naturally heal an underlying problem before it degenerates to the end-stage of the disease,” Dr. Lewandrowski told Becker’s Spine Review.
“If it [reaches the end-stage], it then requires a large, expensive and burdensome reconstruction, which in itself generates the need for complex postoperative care, including more surgeries, admissions and complications, etc.”
The authors suggest spinal endoscopy will lead to more targeted treatments based on direct visualization of pain generators, which may open the door for more simplified surgical pain management procedures over aggressive surgical treatments of end-stage spinal disease.
A growing number of surgeons are recognizing spinal endoscopy’s ability to alleviate pain, according to the paper, not just by decreasing the size of the incision to reduce morbidity, but also to decrease the parameters of reduced blood loss, peri- and postoperative pain and complications.
Drs. Yeung and Lewandrowski laid out two advantages of spinal endoscopy that they believe go unnoticed by most spine surgeons.
First, they highlight the ability to reduce the surgical plan of care to stage the endoscopic treatment plan by focusing on major pain generators.
Secondly, they point to its visualization ability that enables surgeons to view areas in the intervertebral disc as well in the epidural and foraminal space, which facilitates the analysis of pain generators within a spinal motion segment that traditional spinal imaging may not be able to see.
Drs. Lewandrowski and Yeung’s staged management approach implements personalized, preoperative protocols to help understand what pain generator is driving the patient’s disability.
These protocols enable them to substantially reduce the patient’s pain “without having to address the spinal pathology, which in most elderly patients is multilevel,” according to Dr. Lewandrowski.
The peer-reviewed data published by both authors jointly proves that this approach to endoscopic spine care results in favorable long-term clinical outcomes up to five years from the endoscopic index procedure and that early reoperations are uncommon.
If additional treatments were needed due to the natural progression of the underlying disease process, the authors were able to manage new-onset of radicular and mechanical pain from within the same or an adjacent level successfully with another outpatient endoscopic decompression with or without a rhizotomy de-innervation procedure. Only a small subset of patients required an open decompression instrumented fusion procedure to control their symptoms, proving that the staged management approach to spine disease reduces disability, utilization, and cost in the long run.
Go Where Endoscopic Spine Surgery Began
The Bonati Spine Institute was the first ambulatory surgical center in the United States to perform minimally invasive, endoscopic spine surgery with the tools and techniques patented by Dr. Bonati. If you are suffering from back or neck pain, stemming from a spine condition, one of our highly-skilled surgeons can review your case and speak with you directly about how we can help you. To get this review started, please call us at 855-267-0482 or complete our contact form here and a Bonati Institute patient advocate will be happy to help you!
Click here to read the full editorial from the Journal of Spine Surgery: http://jss.amegroups.com/article/view/4706/html
Click here to read the full article from Becker’s Spine Review: https://www.beckersspine.com/spine/item/48141-early-staged-endoscopic-management-of-spinal-diseases-could-change-the-way-we-look-at-spine.html