Among the all surgeries the spine surgery and the brain surgery are considered to be the most complex of all. However, with the advent of MRI scans these surgeries have become quite frequent around the globe. Though the number of surgeries have increased the stigma surrounding them has not decreased. Even today a patient who has to undergo a Spine Surgery is generally frightened with the idea of undergoing a spine procedure and is highly afraid of the complications it may entertain.

Spine surgery has advanced in technology in recent decades. Thanks to the advent of MRI two decades back and microscope. However with the recent development of spine endoscopy  there has been a significant change in the way treatment is done for spinal diseases. this is almost a breakthrough technology in which many of the complications associated with open surgery or microsurgery (Microscope Assisted Surgery) can be easily avoided using the spinal  endoscope. In this article we will look about various aspects of spinal and  endoscopy.

 

 

What is Spine Endoscopy in Bihar ?

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You may have already heard the names like arthroscopy & laparoscopy etc. So any procedure in which we use an endoscope to visualize the inside human body and correct the pathology (problem)  is called endoscopy. Spine endoscopy is relatively a new technique. It has originated from Germany and the best training centers of spine endoscopy are in Germany. The best company Spine Endoscopy Equipment is Joimax GMBH (Germany).

In endoscopy a thin tube like structure called endoscope is used to visualize inside the spine and the problem leading to compression of the nerves is removed using very thin instruments through the endoscope. This is generally done under local anesthesia and patients can be discharged the same day. 

 

Diseases which are treated with Endoscopic Spine Surgery

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Almost a decade back when the endoscopy was introduced as a major change in minimally invasive spine surgery the pathologies which can be treated successfully with endoscopy but only few. This is not because of the technique or the limitations of the vision which you get in Endoscopy, but because of the availability of Limited technology and lack of advanced instrumentation in the field of spine endoscopy.

However, things have changed a great deal in last decade and with the availability of minimally instruments such as flexible forceps and high speed Endo-Burrs, the pathologies which can be addressed with the help of spine Endoscopes have constantly been on rise and now a major portion of spine diseases can be tackled successfully with the help of spine endoscopy. Following problems can be successfully addressed with the help of spinal endoscopy.

1. Herniated Disc

2. Lumbar Prolapsed Inter-vertebral Disc PIVD IVDP

3. Lumbar Canal Stenosis LCS

4. Cervical PIVD 

5. Thoracic PIVD

 

Endoscopic Spine Surgery Technique

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Coming to the technique of spine endoscopy there are few steps which a person undergoing spine endoscopy will pass through:

1. Patient Evaluation: Patient is examined in detail by a spine surgeon and his MRI and X-rays are studied in order to pinpoint the problem location.
   Then the patient is explained about the need for the procedure and afterwards written informed consent is taken before the patient is taken up to the Operating Room for the procedure.

2. Patient Positioning: Now the patient is made to position in the operating table. Different surgeons are comfortable in different positions. Many Surgeons such prefer a prone position. However the original German Joimax technique (TESSYS) is to use a lateral (Sideways) position. In our experience sideways position is better in which the visualization of the Nerve Compression is better & Patient feels more comfortable.

3. Local Anesthesia: After the proper site has been marked the local anesthesia is given in the skin so that the skin is numbed and there is no discomfort to the patient during the procedure.

4.Needle & Endoscope Placement: Then a small needle is introduced and is targeted to the problem area in the spine which is usually a disc. After confirming the position of the needle in the X-ray machine the area is dilated and the Spine Endoscope is put in & Camera is connected.

5. Decompressing the Nerves :- Under the direct visualization of the high magnification of the endoscopic system the disc which is creating compression Is taken out and the nerves are  now free from any compression 

6.The scope is taken out and generally there is no need to put stitches. However sometimes one stitch is put as a precautionary measure.

7.Patients can be discharged the same day after a few hours of the procedure. However in certain insurance policies, a patient is supposed to stay in hospital for 24 hours in order to get the claim and Hospital needs to keep the patient for 24 hours (overnight).

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Symptoms of Nerve Compression

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So the question comes that what are signs and symptoms of Nerve Compression in the spine. The following list states about some of the classic signs and symptoms with which the patient visits to our OPD with impinged nerves in the spine :

1. Pain in Buttocks, back of thigh, calf and foots.

2. Pain is usually more in 1 leg only or it is disproportionate in nature i.e. pain is much more in one leg than in another one.

3. Feeling of tingling, pin pricking and numbness of Hands or Legs.

4. Weakness in legs and hands.

5. Heaviness in Upper Limbs and Lower Limbs.

6. In Advanced cases patients may complain of loss of bladder and bowel control.

 

Benefits of Endoscopic Spine Surgery

 

Is Spine Endoscopy Better than Microdiscectomy/Open Surgery ?

 

Well this question needs a longer answer than a simple yes or no. The results in terms of neurology are generally comparable when it comes to microscopic spine surgery or open spine surgery. However there lies a great difference in which other things are addressed. For Example there is no requirement of general anesthesia in spine endoscopy however in micro surgery as well as in open surgery general anesthesia is mandatory which in itself can lead to multiple complications. General anesthesia requires the patient to stay in hospital for at least one or two nights after surgery & in the case of spine endoscopy the patient can go home the same day only a few hours after the procedure. That is to say that endoscopic spine surgery recovery time is lowest as compared to other traditional procedures. In microsurgery (Microdiscectomy) as well as open surgery there is significant account of postoperative pain which is not the case in Endoscopy because pain is no tissue damage & patient is able to move around just a few minutes after the procedure as there is no general anesthesia given. Also spine endoscopy is more in anatomic in nature as compared to open or microsurgery where you need to cut off & dissect muscles and also take out the bone to reach the target problem whereas in a spine endoscopy no bone is taken out and you go through the natural orifice of the spine that is the spinal foramen. Hence minimal to little damage to the surrounding tissues of the spine leads to  minimal postoperative discomfort. Endoscopic spine surgery cost is also considerably much lower than traditional Microdiscectomy. 

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Comparison with Microdiscectomy & Open Surgery