There are limited outcomes for patients who undergo multilevel open decompression with or without fusion, which has led some physicians to perform targeted endoscopic decompressions instead. Sometimes, patients with failed back surgery are seeking a less invasive approach to pain relief, and targeted endoscopic decompression could be a good solution for them.
"The pain management community is ideally positioned to partner with a safer approach to surgical correction, such as endoscopic decompression or other minimally invasive techniques, to reduce long-term disability in the growing population of patients with degenerative disc disease," says Robert Gruber, DO, director of spinal diagnostics and therapeutics at Laser Spine Institute in Tampa, Fla. "The diagnostic skill set of the interventional pain physician uniquely prepares him or her to identify these patients and encourage an informed decision about surgical options available."
Dr. Gruber discusses four points on targeted endoscopic decompressions.
1. Serves as an alternative to open surgery. Some patients may be afraid to undergo open spine surgery or other interventional treatment because of the risks associated with the procedures, so they'll put off surgery. Targeted endoscopic decompressions might be the appropriate solution for them because they are a less invasive intervention. "Using the same skill set that we already possess in targeting the site of a transforaminal epidural, we can now consider a targeted endoscopic removal of the bone spur at the most anatomically significant site of compression or stenosis," says Dr. Gruber. "Because the intervention is so much safer, patients don't put off surgery and they experience relief much earlier in the disease process."
2. Targets patients on the anatomic level. A steady philosophical shift is taking place in spine care from treating patients at the physiologic level of the problem to target the primary anatomic cause. "If you look at the cases of symptomatic lumbar spinal stenosis today, there is a primary anatomic cause for the pain, such as arthritic spurs or hypertrophic ligaments, which remain and progress as a source of nocioceptive stimulation," says Dr. Gruber. "While short-term relief does occur, there's usually a pattern of decreasing effectiveness over time."
3. Eliminates multiple intervention sites. In the past, a surgeon might find the general source of the pain and decompress multiple spaces around the area for pain relief. However, the targeted endoscopic decompression technique allows the surgeon to find the exact source and decompress at one site instead of two or more. Patients with multilevel compression might require more than one endoscopic decompression, but the intervention still poses less risks than the more traditional "get it all while we're in there" approach, which could result in a broad decompression of symptomatically irrelevant areas of stenosis, says Dr. Gruber.
4. Decreases complication rate. Targeted endoscopic decompression is a less invasive procedure than the open approach, which means the infection rate is lower and there is less risk of complications. Additionally, the patients are able to use fewer narcotics and begin rehabilitation quicker because less of their anatomy was disrupted.
Learn more about Laser Spine Institute.
Read other coverage on spine surgery and treatment:
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 4 Biggest Opportunities in Spine Surgery From Spine Surgeon Dr. Jay Khanna of Johns Hopkins
- 10 Points on Robot-Guided Spine Surgery
"The pain management community is ideally positioned to partner with a safer approach to surgical correction, such as endoscopic decompression or other minimally invasive techniques, to reduce long-term disability in the growing population of patients with degenerative disc disease," says Robert Gruber, DO, director of spinal diagnostics and therapeutics at Laser Spine Institute in Tampa, Fla. "The diagnostic skill set of the interventional pain physician uniquely prepares him or her to identify these patients and encourage an informed decision about surgical options available."
Dr. Gruber discusses four points on targeted endoscopic decompressions.
1. Serves as an alternative to open surgery. Some patients may be afraid to undergo open spine surgery or other interventional treatment because of the risks associated with the procedures, so they'll put off surgery. Targeted endoscopic decompressions might be the appropriate solution for them because they are a less invasive intervention. "Using the same skill set that we already possess in targeting the site of a transforaminal epidural, we can now consider a targeted endoscopic removal of the bone spur at the most anatomically significant site of compression or stenosis," says Dr. Gruber. "Because the intervention is so much safer, patients don't put off surgery and they experience relief much earlier in the disease process."
2. Targets patients on the anatomic level. A steady philosophical shift is taking place in spine care from treating patients at the physiologic level of the problem to target the primary anatomic cause. "If you look at the cases of symptomatic lumbar spinal stenosis today, there is a primary anatomic cause for the pain, such as arthritic spurs or hypertrophic ligaments, which remain and progress as a source of nocioceptive stimulation," says Dr. Gruber. "While short-term relief does occur, there's usually a pattern of decreasing effectiveness over time."
3. Eliminates multiple intervention sites. In the past, a surgeon might find the general source of the pain and decompress multiple spaces around the area for pain relief. However, the targeted endoscopic decompression technique allows the surgeon to find the exact source and decompress at one site instead of two or more. Patients with multilevel compression might require more than one endoscopic decompression, but the intervention still poses less risks than the more traditional "get it all while we're in there" approach, which could result in a broad decompression of symptomatically irrelevant areas of stenosis, says Dr. Gruber.
4. Decreases complication rate. Targeted endoscopic decompression is a less invasive procedure than the open approach, which means the infection rate is lower and there is less risk of complications. Additionally, the patients are able to use fewer narcotics and begin rehabilitation quicker because less of their anatomy was disrupted.
Learn more about Laser Spine Institute.
Read other coverage on spine surgery and treatment:
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 4 Biggest Opportunities in Spine Surgery From Spine Surgeon Dr. Jay Khanna of Johns Hopkins
- 10 Points on Robot-Guided Spine Surgery