Dr. Joshua - can you please tell me how to research the new minimally invasive surgerys? The longevity etc. - If they really work etc in the long term, or do we know yet?

I talked to the spine institute in florida, and they will review my MRI for a second opinion. The next day they called and said they could fix all my back problems with a laminotomy/foraminotomy. They told me this would fix the degenerated and bulged disc and cauterize it, where it would regain height and eliminate the bulge. They said it would remove the bone spurs and open up the foramen. They told me this would be a permanent fix. Minimially invasive one inch scar. Not cutting any muscles. Easy recovery. Short surgery while only sedated twilight.

Is it possible that this is true they could fix it all just like that, no big deal? They told me that the old traditional laminectomy will be done away with in the future as it removes the whole lamina which causes instability.

Can you please give me your opinion, knowledge and/or tell me how to research.

If it were your spine….what would you do??

Thank you so much yvette.

Finally appointment at teaching hospital tomorrow.

Doctor Joshua’s Answer:

Properly done, modern microdiscectomy is minimally invasive. A regular lumbar microdiscectomy is done under an operating microscope, and the material compressing the nerve is removed. If the disc itself is not removed, this is a minimally invasive procedure with excellent results and low risks. There are some spine surgeons who retain that not removing the disc will increase the likelihood of relapse, but there is not sufficient evidence to support this.

From a neurosurgeon’s point of view, the aim of such procedures is not to specifically remove disc material or bone, but to release the compressed neural tissue, meaning the nerve root in most cases. In order to achieve this, the herniated disc material and possible osteophyte (bone spur) or other tissue that cause narrowing of the recess is which the nerve lies, are removed.

A one-inch scar is the norm in standard microdiscectomy. Actually, the procedure should most times be called microdecompression, which would better describe the procedure - whatever tissue is compressing the nerve is removed, be it herniated disc, bone, facet hypertophy, etc.

Laminectomy is not often done anyway - it’s not a future trend, it is current practice in spine surgery to avoid laminectomy.

Laminotomy with electrocoagulation (cauterization, nucleoplasty) of the disc is no more minimally invasive than a microdecompression performed according to the above explained principles. It is actually somewhat more invasive, because the disc is cauterized, whereas in a microdecompression, just the offending tissue is removed.

Nucleoplasty (which can mean either electical coagulation of the disc or removal of disc material via a percutaneous technique) is not exactly a new technique, but it is gaining popularity and it seems that it may be a suitable procedure for carefully selected patients who have a contained disc herniation and often these patients may have slightly atypical (unusual) symptoms. Usually, nucleoplasty is done percutaneously, with just a needle through the skin, in which case it is truly a minimally invasive procedure. It is not usually done when there is deemed to be need for a microdecompression/microdiscectomy anyway.

The long-term outcome of nucleoplasty has not been sufficiently studied, but it seems to be at least comparably safe and well tolerated procedure as microdiscectomy.

Regarding the claim that someone could fix all your back problems with a single procedure, I would approach such a claim with great skepticism to say the least, especially given your complex history of back problems. I never make such claims, and I don’t recommend surgery if I haven’t personally examined the patient.

If I understand correctly, what they are suggesting is in effect a combination of microdecompression and nucleoplasty. This seems unusual, but of course I cannot give you a second opinion or make any treatment suggestions over the Internet, so I definitely recommend that you follow your own neurosurgeon’s advice in this matter. I’m sure the surgeon who recommended this procedure has his reasons and is willing to explain why he thinks this is the best procedure for you.

I hope that the information I have given is helpful to you in trying to understand these procedures.

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