Advanced spine endoscopy

Lumbar herniated disc and spinal stenosis are the pathologies that are better recovered with advanced spine endoscopy.

With spinal endoscopy we can mill or drill all the bone structures that compress the exit of the nerves, both the sheets of the medullary canal and the foramen through which they exit

The first phase of endoscopic spine surgery requires approximately 30 minutes:

• The patient is anesthetized, in most cases of a general type.
• The positioning of the patient for this surgery must be precise: prone position with padding on the chest and pelvic region. Tilting in flexion of the lower extremities.
• Anteroposterior and lateral projections are used to accurately identify the approach and entry of the endoscopic optical camera.

The second surgical phase usually takes about 45 minutes:

• Once the level to be treated has been radiologically identified, an incision is made in the skin of less than 1 cm.
• Once inside the spinal canal, the separation of the compressed root is performed to extract the herniated fragment. It is essential to ensure complete root release by exploring the course of the nerve and reviewing the interior of the disc. 
• Subsequently, in certain cases, the stem cells will be implanted

The total duration of advanced spine endoscopy is usually 75 minutes.

To highlight the advantages of the advanced endoscopy of the spine that we perform in Madrid, it is necessary to compare this technique with microdiscectomy and open surgery, which are also used for the treatment of lumbar herniated disc and spinal stenosis.

• Minimum tissue aggression and rapid recovery after surgery
• Endoscopy provides a high-definition view that cannot be obtained with the naked eye or with a microscope.
• The incision in the skin is less than 1 centimeter.
• -Tissue aggression is minimal and, therefore, postoperative pain decreases, hospital discharge is almost immediate after the intervention and the risk of complications also decreases.
• Allows the treatment of pathologies both in the spinal canal and in the foraminal-extraforaminal.
• Less risk of degenerative complications and spinal instability that may require more aggressive surgeries such as interbody arthrodesis (screws and bars).
• Decreases bleeding compared to open surgery or microdiscectomy.
• Less risk of infection thanks to the minimal incision made in advanced endoscopy of the spine.

The previous study is essential and must include the following complementary tests: lateral, anteroposterior and functional radiographs in maximum extension and flexion of the lumbar spine; MRI and neurophysiological study with electromyoneurogram.

The patient must have maintained symptoms derived from compression of the lumbar herniated disc  or spinal stenosis without significant relief with anti-inflammatories, analgesics or antineuritic drugs for at least 6 week.

Sometimes the symptoms are so severe that the patient cannot bear the pain and earlier surgery is necessary.

Two or three days before surgery, it is preferable not to take anti-inflammatories and only maintain treatment with analgesics to avoid the antiplatelet effect. This protocol is not essential, but less bleeding is achieved during surgery and, therefore, less coagulation of bleeding points.

In the case of herniated disc, we add the implantation of concentrated stem cells to the advanced endoscopy of the spine, one of the most advanced and innovative treatments in biological research.

Our goal is not only to relieve the patient's pain with the endoscopic removal of the herniated disc that was compressing the nerve or the space of the neurological structures with a percutaneous technique that does not injure the tissues. In addition, with the stem cells we achieve the complete regeneration of the intervertebral disc and recover its function, to avoid osteoarthritic degeneration of the disc and the vertebral joints.

The cellular differentiation of stem cells increases peridiscal vascularization and innervation, improving the diffusion of nutrients to the disc components that have been partially removed or damaged: the nucleus pulposus and the annulus fibrosus.

Stem cells are extracted from the iliac crest of the patient's pelvis, through a minimal 3mm percutaneous incision and puncture/aspiration with a fine needle inserted into the bone.

After extraction, a specific centrifugation is carried out in the laboratory and a cell concentrate is obtained, which is introduced into the area of the intervened disc with endoscopy as a guide. It is performed during endoscopic surgery in which the hernia has been removed or the neurological structures of the spinal or foraminal canal have been decompressed.

With this advanced spine surgery technique, an improvement in lumbar pain is achieved and, in many cases, a regeneration of the intervertebral disc.

Upon discharge from hospital, the patient must receive the medical report specifying the surgical findings and the technique used.

In relation to post-surgical medication, anti-inflammatories - analgesics are used the first few days as required. Generally, an analgesic drug is usually sufficient, although it is better to complement the report with two alternatives in case it is necessary. Muscle relaxants are only used in case of lumbar contracture.

The surgical wound is about 0.5 cm in the posterior or lateral part of the lumbar region. A stitch or staple is usually given. We can wash the wound from the 5th day, keeping it clean and dry with betadine or chlorhexidine cures. There are usually no complications of infection or wound openings due to its small size. With endoscopic surgery, continuous washing is performed through the endoscopic lens, so the risk of infection is minimal.

A lumbar belt is not required and after the first 15 days physical activity can be increased. From the first day, it is advisable to carry out movements of the thoracolumbar spine without excessive energy: flexion-extension, lateralization and rotation. Bad posture or handling of heavy loads should be avoided in the first month.

If there is any lumbar discomfort due to muscle contracture, in relation to the surgical posture, we can apply local heat for 20 minutes 3-4 times a day and perform progressive stretching exercises.

If residual lumbar pain remains, the exercises can be complemented with a physical rehabilitation session, it is always advisable to go hand in hand with the best spinal traumatologists in Madrid so as not to go back.

Driving the car can be done immediately in the first days, it is recommended to use a cushion in the car under the first few days to avoid increasing abdominal and intervertebral disc tension.

In the event of any complication or incident, consult the emergency service of the hospital center where you underwent surgery.

Recovery after endoscopic spine surgery is very fast, since the skin incision is only 1 cm long and the placement of a drain is not necessary.

The pain disappears immediately after the surgery. Sometimes, if the nerves have been compressed for a long time or intensely, tingling (paresthesia) or numbness (hypoesthesia) occurs, which gradually disappears in a few weeks.

The patient is discharged from the hospital the same day of the operation once he recovers from the surgical anesthesia. Support and walking are started immediately and on the return home crutches or a wheelchair are not required. Daily activity is recovered during the first week and, in the case of practicing sports, it is resumed after the sixth week.

It is worth noting the importance of avoiding intense physical exertion before the third month, but physical progression helps early recovery. Exercising is always positive moderately.

The wound is so small that it does not require intensive care. Simply, it is kept clean and dry until the first revision, 7-10 after the operation, where the first dressing is performed and the stitch is removed.

It is essential to maintain the muscles of the back and abdominals with good muscle tone. Stretching exercises that improve thoracolumbar elasticity or strengthening exercises should be performed periodically to have a structured back and avoid discomfort and relapses.

Maintaining a good weight and healthy habits (smoking or eating) help to avoid back pain.

The results studied in the short and medium term are very good without requiring, in most cases, revisions or new spinal surgeries due to complications. With the implantation of stem cells in the damaged intervertebral disc, its clinical improvement and its prevention in the evolutionary degeneration of the spine are studied. Control is usually done in consultation in the first 15 days after surgery and a month later. If stem cell implantation has been carried out, check-ups are annual to see the evolution of improvement of the intervertebral disc in MRI.