An article published in the Journal of Neurological Disorders examines the hybrid procedure of endoscopic decompression, foraminalplasty and dorsal rhizotomy for patients with foraminal stenosis and lumbar spondylosis as an alternative fusion.
Written by Phoenix-based Desert Spine Institute's Anthony Yeung, MD, the article examines how the hybrid procedure can provide an alternative to spinal fusion. "Spine surgeons trained to perform fusions with no training in endoscopic surgery are battling an economic crisis of escalating cost and affordability when fusion surgery is recommended for chronic back pain," he wrote.
Spinal fusion includes expensive implants and instrumentation, and payers consider it economically unsustainable due to the added hardware costs. They are denying preoperative authorization payments, making it more difficult for surgeons to treat patients. However, Dr. Yeung argues a surgeon with experience in endoscopic foraminal surgery and visualized dorsal rhizotomy can achieve better results.
The article describes the surgical technique for endoscopic transforaminal decompression for patients with chronic back pain. The study found average VAS and ODI scores improved after the procedure. "Because of the excellent results from the pilot study, the second phase of the study evolved from visualizing additional nerves during endoscopic foraminal decompression. It was discovered that foraminoplasty also provided back pain relief," wrote Dr. Yeung.
He was able to provide a warrantee for his results after refining patient selection and gaining experience with the endoscopic technique. Dr. Yeung used shared decision making with the patient, giving the option for the transforaminal procedure and a more traditional open procedure. The technique now has more predictable outcomes, according to the study.
"Hybrid endoscopic transforaminal decompression, combined with dorsal rhizotomy will open the door for early cost effective surgical solutions for painful degenerative conditions of the lumbar spine in lieu of fusion," concluded Dr. Yeung. "This hybrid technique warrants further study and adoption by surgeons trained adequately in this technique."