What is Endoscopic Spine Surgery

In endoscopic spine surgeries, we use a thin, tubular instrument called endoscope that contains image transmission, illumination, irrigation, and a working channel. Endoscope can be placed at an area of interest using a small (< 1 cm) stab incision and sequential tissue dilation. In “Full Endoscopic” spine surgeries, constant irrigation by sterile fluid is done to maintain visibility, to control bleeding, to cool tissue when radiofrequency or laser are being used, and to wash out surgical debris.

Endoscopic spine surgeries can be used for patients suffering from acute / chronic back or neck pain, radiculopathies due to cervical / lumbar degenerative disc disease or herniated discs.

Dr Ashish Dagar, at New Delhi Spine, is a pioneer in endoscopic spine surgeries. Being a minimally invasive technique, approach related tissue damage is close to nonexistent, resulting in faster and better postoperative recoveries. Using this technique, we are doing several procedures which includes but are not limited to

CERVICAL SPINE

  • Endoscopic discectomy
    • Anterior Trans-discal approach
    • Posterior Interlaminar approach
  • Posterior Endoscopic Cervical Foraminotomy and Discectomy
  • Endoscopic anterior cervical discectomy and fusion surgeries
  • Endoscopic cervical disc replacement

THORACIC SPINE

  • Endoscopic Thoracic Discectomy
  • Endoscopic Thoracic Decompressive Laminectomy
  • Endoscopic decompression in infections / trauma in Thoracic spine
  • Endoscopic release in scoliosis surgeries

LUMBAR SPINE

  • Endoscopic discectomy
  • Endoscopic foraminotomy
  • Endoscopic decompression for spinal canal stenosis
  • Endoscopic Annuloplasty / Nucleoplasty
  • Endoscopic transforaminal lumbar interbody fusion
Best Endoscopic lumbar surgery Hospital in delhi, India - New Delhi Spine

Types of Endoscopic spine surgery Techniques / Approaches

Broadly speaking two endoscopic approaches to the lumbar spine are defined. One is transforaminal and the second one is interlaminar:

In transforaminal approach, further two techniques are described

In - Out technique and Out – In technique. Both techniques involve going inside disc space, creating an annular defect in the foraminal region. Both techniques have a high failure rate because of

  • Technique itself requires making a new annular defect which can be a fresh site for herniation
  • Damage to end plates while placing working cannula inside disc space can lead to chronic back pain
  • All surgical steps take place at neural foramen which is an anatomically narrow zone. Any postoperative fibrosis will cause further narrowing and entrapment of the existing nerve root.

In the Interlaminar approach – various techniques have been described. What we do here at Delhi spine is PSLD – Percutaneous Stenoscopic Lumbar Decompression and PSCD – Percutaneous Stenoscopic Cervical Decompression.

Best Endoscopic lumbar surgery Hospital in delhi, India - New Delhi Spine

WHY PSLD / PSCD?

PSLD and PSCD combine advantages of endoscope to current gold standard microscopic posterior spinal surgeries.

In PSLD/PSCD each instrument is inserted one after the other through the working channel of the endoscope with direct endoscopic visualization. The endoscope is articulated at the distal end (usually by 11 - 15°) and permits visualization “round the corner.” Rotating the endoscope permits visualization of a large intraoperative area. Permanent irrigation and aspiration of isotonic saline solution during the operation permits optimum vision at the surgical site. The full-endoscopic procedure achieves a significant reduction in the diameter of the surgical access port (7–10 mm) for spinal decompression.

In addition, PSLD / PSCD endoscopic techniques give us freedom to do traditional fusion and replacement surgeries using endoscope. So, Endoscopic Cervical Artificial disc replacement, Endoscopic Anterior Cervical Discectomy and Fusion and Endoscopic Transforaminal Lumbar interbody fusion are a reality at New Delhi Spine.

Surgical procedure

If you are considering PSLD / PSCD (Endoscopic Spine Surgeries) as one of the treatment options to solve the problem of spinal disc degeneration, you probably have many questions about the surgical procedure. So, to answer your questions, in the following paragraphs we give you a detailed description of the steps involved in the operation.

At New Delhi Spine, in addition, we have the Dynamic Life Recovery System (DLRS) for patient to guide them throughout the process, from getting prepared for the surgery and all the way through their recovery periods.

Before The Surgery

Endoscopic spine interventions, like any surgical treatment, involves a detailed assessment of each case prior to the surgery. To have this done, patients should contact the New Delhi Spine to make an appointment at which they will be able to provide the specialist with all the necessary information.

In approximately one week after we have all your necessary information, you will receive the complete evaluation of your case from the specialist. In some cases, the doctor may tell you that some additional tests are needed before surgery. From this moment on, the preoperative preparation steps included in our DLRS program will be activated, which include specific protocols to reduce stress and make this stage of the process easier.

In the event that the patient has previously undergone any treatment (surgical or non-surgical) to treat the pain caused by the disc degeneration problem, it is important that you tell us so that the surgeon takes it into account before the intervention. Also, it is essential that you know your medical history and inform us of any medical conditions and any treatment that you are currently following.

During The Surgery

When the scheduled date for the operation arrives, the protocols of our DLRS program for surgery are activated, which aim to facilitate this stage of the process.

The patient is admitted to the hospital one day prior to operation. They will need to abstain from eating or drinking anything for at least 6 hours prior to the scheduled surgery time. While waiting for the operation, the patient will be in a hospital room, where he or she can be accompanied by his family and friends.

After this, the patient will be taken to the surgical area where the anesthetist will ask them some questions and then the patient will be asked to sign an informed consent of the possible risks related to anesthesia.

Next, the operation, which usually lasts about an hour, will be performed by the spine surgeon at the lumbar or cervical level. Although it depends on each case, as a guideline, when the operation involves more than one level of spinal disc, each extra level takes about fifteen minutes more.

When the surgery is over, the patient is awakened in the operating room and transferred to a recovery area, where he is monitored for about two hours before being taken to their hospital room.

The discharge from the hospital will depend on each patient’s case. On the average, the patient stays for one day after surgery.

It is totally normal for the patient to feel discomfort in the area of the surgical incision or in the cervical or lumbar area, but this will subside over the next few days.

Patient post-operative and recovery phase

Recovery from endoscopic surgery, whether cervical or lumbar, is a gradual process, and it is normal for the patient to notice some discomfort. During the first week after surgery, we recommend that the patient take short walks, and exert no effort that causes stress. A follow-up visit is scheduled for the patient between 7 and 10 days after surgery. At this appointment the surgical wound is inspected and the suture strips are removed.

After that point, as a general recommendation, the patient should not exert any stressful effort or adopt bad postures during the first three months after surgery, and especially during the first month. They will be able to start swimming one month after surgery and run or ride a bicycle after the first 3 months.

After about 3 weeks, the patient can return to work if it does not require physical effort. For patients whose professional activity requires physical exertion, they can usually return to work about 6 weeks after the operation. In addition, we recommend that the patient have supervised rehabilitation sessions in a specialized physical therapy center.

Apart from the general recommendations, there are specific indications depending on whether the intervention was in the cervical or lumbar spine. At New Delhi Spine we do not recommend the use of lumbar belts on a routine basis. They are only indicated in some cases, for a short period of time.

Of course, the recovery steps recommended will depend on each patient and will be made in a totally personalized way in each case. At New Delhi Spine we accompany the patient throughout the process. In addition, the staff continues to be available so that the patient can ask any questions about recovery through the usual channels such as telephone or email.

Control Of Postoperative Pain

Postoperative discomfort or pain is normal, but at New Delhi Spine we do our best to ensure that this phase is as easy as possible for the patient.

During the hospital stay, the patient will receive painkillers intravenously to alleviate this post-operative discomfort.

Upon discharge, oral medication will be prescribed by the doctor according to each case. This will be gradually withdrawn on advice of the doctor at the following visits to New Delhi Spine.

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