Not everyone can be helped and not everyone is satisfied. This is, after all, still spine surgery. We do sincerely believe that in those that are not improved the negative consequences of the open techniques are at least avoided. This is the next step in the treatment of spinal disorders. It is now the cutting edge and most advanced but we all know that in the continuum of life and learning that there will be new great advances in the decades to come.
One thing you can be assured of; if we do not believe we can help you we will not push you into surgery. Our future success depends on good results and word of mouth testimonials. We cannot afford to have poor results!
Microsurgery only implies the use of the microscope. The size of the incision and the extent of collateral tissue destruction are of no bearing. Therefore the names are similar but they are completely different.
An endoscopic discectomy uses similar techniques as the endoscopic sports medicine orthopedist a small piece of the offending disc is removed to alleviate nerve pressure. The amount of disc removed is normally less than 5-10% of the total of the disc.
Jose Rodriguez, M.D. is board certified by the American Board of Spinal Surgery. In order to be board certified by this board a surgeon must first be board certified in Orthopedic Surgery or Neurosurgery and perform a large number of spine cases. Obviously Orthopedic Surgeons are the specialists of joints and Neurosurgeons of the brain; spine is a crossover area.
Those Orthopedic Surgeons and Neurosurgeons that are certified by The American Board of Spinal Surgeons have made a conscious effort to master the techniques of the others’ specialty necessary to the successful performance of spinal surgery. Therefore those Neurosurgeons and Orthopedic Surgeons who have made this step are all equally qualified and capable.
The objective in this difficult situation is to free up the nerve to permit more freedom of movement and less pressure by removing the surrounding bone and soft tissue causing the compression.
Minimally invasive spine surgery involves an incision of less than an inch. Spinal surgery with an incision of greater than an inch is therefore not minimally invasive. When Jose Rodriguez, M.D. does perform a microscope assisted spine procedure as opposed to a minimally invasive spine surgery, an incision of two to three inches is the norm. There is a big difference.
There is one disadvantage, since we have to operate through a tiny hole we are limited in the amount of surgery that can be performed through that hole. If you have spinal stenosis at multiple levels, we cannot perform all the surgery at one time because each level takes about two hours and there is a limit to how a person is comfortable awake on an operating table. Most, however, can be managed with one or occasionally two procedures.
Most require little to no physical therapy post operatively. Some do but it is not for long. A gradual return to normal activities over a few weeks is often the best therapy.
In this procedure a tube (or cannula), is inserted into the disc in order to suck out the contents of the disc. Unfortunately, it doesn't decompress the disc enough. It is really necessary to remove the fragment of disc causing the symptoms and decompress the disc properly. This can only be done “open” or with minimally invasive laser spine surgery techniques. The risks are no different.
here is no easy solution to the problem of “Discogenic Pain”. Jose Rodriguez, M.D., as all the other spine surgeons of his generation, has performed literally thousands of procedures for this type of problem in years past, but with the passage of time and the benefit of well designed investigative studies, in hindsight the spine community is no longer enthusiastic about the long term results of fusion for this disease.
It is a tremendous amount of surgery to address a very small lesion (an annular tear). While disc related pain is one of the most difficult problems we face there are nevertheless several minimally invasive laser treatments that can improve disc related pain without resorting to a fusion or an artificial disc (which is being shown to have its own set of negatives). Plasma Disc Decompression and endoscopic laser assisted discectomies offer success without the hardware, fusion or the attendant complications. There are also some experimental injection therapies for those interested in a more adventurous potential solution!
We cannot reverse the aging process but we have several procedures that treat the results of spinal arthritis, permanently in many cases. Radiofrequency nerve ablation of the facets (facet rhizotomy), is a very effective procedure to take away pain that comes from the arthritic facet joints. The problem is that it does not seem to be permanent. The laser assisted minimally invasive procedure that we use is in some ways similar to the radiofrequency facet rhizotomy procedure but it appears to be a permanent solution for the majority.
Myeloscopy (otherwise known as Epiduroscopy), is really, at least for the most part no better than performing the same procedure by way of an epidural steroid injection or a localized injection using the Racz catheter technique. This technique was an important stepping-stone in our techniques and understanding of the minimally invasive approach. While we have performed this procedure in the past we believe that the newer techniques have super-ceded it.
Your spine cannot be straightened with these techniques but areas of nerve compression can be relieved by de-compressive endoscopic laser approaches.
If the screws are properly placed in the pedicles they are not usually a problem, however, the plates or rods may lie in the way of the endoscopic approach and the fusion mass if copious may well interfere with a direct approach to the area where the surgery needs to be performed. It is often possible to either work around the implanted hardware or remove a part of it in order to access the site of the pain generator to be treated.
First we can pre-screen you by reviewing you MRI and records. We can usually give you a pretty good idea as to whether these techniques might be of benefit to you, if so, then you can come for the formal evaluation and treatment process.
The major issue with conventional surgery is that it is too destructive in its approach for the problem that is being treated. The larger the incision the more the collateral damage and consequential scar tissue that forms. This scar tissue in turn can be the result of future difficulties. This is why even after an initially successful open procedure the pain may return over the ensuing months.
Obviously, it is fantastic for those who can be helped. The reason is simple: by taking a fresh look at your problem in light of these new procedures and techniques what previously seemed impossible may suddenly become a reality. There are no miracles or guarantees, but the results of these techniques are often amazing.
It is possible to improve nerve entrapment pain due to scarring from prior surgery. Arachnoiditis or scar tissue is a combination of scar tissue and ongoing nerve root compression. Scar tissue tends to act like a "space occupying lesion" and thus compresses the nerve in an already tight canal. Once the foramina is opened and the scar tissue is removed the pain will generally decrease.
With minimally invasive laser procedures we can see the problems often better than with open procedures. There is less destruction of normal tissues, which reduces new post-operative complaints.
What we can see during surgery with the magnification and direct illumination is remarkable when compared to the visualization during an open operation. It is just like the difference between open knee surgery and endoscopic knee surgery. No one any longer doubts the incredible benefits of endoscopy of the knee. It is similar with the spine.
Problems that are difficult to resolve with conventional surgery are often quite amenable to the endoscopic laser approach. There is less scar tissue and trauma as a result of the operation itself and this results in our ability to improve your problem without creating new ones.
Through the use of these advanced techniques many problems can be resolved when related to the disc, bone or scar tissue even though over many patients may have had previous spinal surgery. These techniques are like a fresh look at an old problem so while not everyone can be helped it is not yet the time to despair!
IDET or Intradiscal Electrothermal Coagulation is a procedure where a thin wire is inserted into the disc and then wrapped around inside the disc. The wire is heated so that the disc coagulates. The idea is that this will heal the tear in the annulus. Jose Rodriguez, M.D. has performed many of these procedures in the past. Unfortunately the results are not much different than a placebo procedure and hence the interest in this simple procedure has waned. Furthermore, the IDET is not indicated where there is an actual disc herniation but rather for discogenic lower back pain. Its indications are thus limited and its results questionable.
There are others performing similar procedures. Some have never had the experience of performing open procedures. Where we differ is that Jose Rodriguez, M.D. brings a long-standing experience in all endoscopic surgery along with years of experience in the treatment of spinal disorders by all open techniques. Furthermore because of his years performing invasive pain procedures to identify and treat pain generators he brings a rather unique combination of experience and technical skills to the table that permit an in-depth analysis and understanding of your spinal problem.
After the appropriate recovery period if the problem is still present it is necessary to start over and attempt to identify the pain generator. Only if the pain generator is reliably identified can further surgery be contemplated. No matter how good these procedures are, we cannot help everyone. There will always be a few patients whose nerve damage is irreversible using even these advanced techniques. Sometimes a revision or another procedure may be in order.
If a disc is causing pressure on the spinal canal contents or on a nerve root then the herniated portion will be removed. In most cases this will remove the pressure on the nerves. Most of the disc remains as only the small piece that is actually causing the problem is removed.
It is thought to be by some but in reality these techniques have been slowly developing and evolving over the past 10 to 15 years at least. Tens of thousand surgeries have been performed around the country with incredible success.
A Laminectomy is the usual open technique, and we do not often need to perform this when doing these endoscopically assisted laser procedures. With a Laminectomy the entire lamina is removed. We perform an endoscopic Laminotomy. This is essentially the removal of just enough bone to see and free up the nerve root but no more. Hence, we can do the operation with local anesthesia. A Discectomy is performed when the pressure on the nerve root is from the soft disc tissue.
Laminectomy and Discectomy have been used interchangeably in this past for two reasons. First, in order to perform a Discectomy by an open spine technique you need to perform a Laminectomy to get to the disc to perform the Discectomy. Second, the billing code is the same for both procedures because of the need to remove the Lamina to get to the Disc. We do a Laminotomy if there is a bone problem and a Discectomy if the problem is from the disc itself. With these techniques we can perform only the procedure that is required to handle your problem.
Because the recovery time is typically days not months for these procedures it is not necessary for you to be followed up after the initial week with us. We will, however, be making contact with you via telephone to check on your progress. you should check in with your primary care physician.
You can return to driving and other activities of daily living usually within twenty-four hours.
Even though significant savings can be had by the performance of these surgeries in the outpatient setting, Medicare only reimburses for when they are provided as inpatient. Perhaps this will change in the future.
We are not in network with any insurance companies because these procedures are considered by some to be experimental and the proper billing codes are not available for some procedures. Furthermore, by not taking on the responsibility for billing and collection we can keep the price of the procedures down, passing on the saving of not having an insurance billing and collection staff to our patients.
These procedures require a unique combination of skills that take time to acquire. They are cutting edge techniques. We believe that with time these procedures will replace most open surgery of the spine just as open orthopedic knee and shoulder surgery has been replaced by endoscopic techniques. The same is true of general surgery as well as gynecological surgery and urology. This the future and it is available today!
You must not take any drugs that contain aspirin or anti-inflammatories two weeks prior to surgery. If you are on anticoagulants, consult your doctor about discontinuing them prior to coming for surgery. As far as other medications are concerned, we need to know everything that you are taking prior to undergoing the laser procedures.
You need to have someone with you to either drive you home or stay with you at a local hotel after your surgery. We can assist you in these matters.
Each case is different but the type of evaluative procedure is the same. If the pain generator can be identified then we can usually help. Scar tissue from a previous open back surgery can be a possible pain generator too. It can frequently be removed by minimally invasive techniques.
We do not want you to lift anything over 10-15 lbs for six weeks. You can return to normal activities gradually after that to help prevent re-injury in the early post-operative period. If you do mainly office type work then you can return to this type of activity as soon as you wish usually within a few days. If you need to lift objects heavier than 10-15 lbs, then you either only return at light duty or wait six weeks.
If you are from out of town, you must stay within 25 miles of us while you are here. There are numerous hotels close by. Normally it is a five-day process, but this can vary from individual to individual. You should plan to remain close by for a week for each surgery planned.
It depends. During the initial examination and upon review of the pain generator results we will determine what and how much surgery you may need. It will depend upon the extent of the damage and the number of levels/locations involved. The one disadvantage of the minimally invasive approach is that we can only address one small area at a time. If your disease is extensive and diffuse more than one procedure could be necessary. For most people, the problem once located, is focal and one procedure is usually all that is necessary.
Call us or better yet submit your medical records, imaging studies and a one-page description of your symptoms by e-mail, fax or mail. We will tell you if you are a potential candidate for our procedures. All at no charge.
By freeing up the stenosis the impingement on the spinal or foraminal canal can be decompressed thereby relieving the pressure on the nerve which in turn usually relieves the pain. In fact the laser spine surgery techniques work well for spinal stenosis because we can remove small pieces of disc and/or bone that impinge upon the spinal nerves under direct vision assuring that the nerve pressure is resolved. Most importantly, because you are awake during the procedure you are able to alert us as to when a sufficient decompression has been accomplished.
It is not necessary. The patient is sedated and comfortable during the spine procedure. This permits the surgeon to know when he has relieved the problem because you can tell him when it happens! One less bit of guesswork! Local anesthetic is injected where the small cut is to be made. Intravenous medications keep the patient comfortable but alert.
Due to the lack of general anesthesia and the minimal blood loss the complications are very low when compared to traditional open surgery. The procedures are minimally invasive requiring only a small incision typically ¾ of an inch or less. Infection at the incision site can occur but is uncommon.
The Center for Laser Spinal Surgery does not contract with any third party insurance. If you have out of network benefits, then you can submit our bills to your insurance company to receive reimbursement directly. Usually the costs are a fraction of that involved in open spine procedures. It depends upon whether or not you need additional imaging studies, the amount of pre-operative investigation necessary and the extent of the surgery required.
Endoscopic spinal surgery is a technologically advanced, minimally invasive way to perform spine procedures and to treat spinal problems with very little blood loss or scarring