Transforaminal Endoscopic Lumbar Decompression & Foraminoplasty
For the most advanced degeneration we have developed the technology to address these problems with keyhole surgery minimising disturbance to the spinal canal contents whilst using the bloodless cut of the laser to maximum advantage.
When the disc contents have protruded or burst out of the disc space into the spinal canal this disc, disc or material is usually retrieved by means of an open Fenestrectomy. Following the feedback from spinal probing and discography, the endoscope can be guided along the exiting nerve root, through the foramen and into the anterior epidural space. Clearance of the anterior intradiscal space can be effected with the side-firing laser probe Holmium laser wavelengths and graspers. A tear in the disc wall can be seen and an intradiscal clearance can be performed to clear remaining disc material from within the disc to prevent recurrence and an annuloplasty can be performed to shrink the wall of the disc and reduce a disc protrusion.
This technique can be also be used to decompress lateral recess stenosis. Conventional treatment would be a fenestrectomy or laminectomy with undercutting of the lateral recess from within the spinal canal. It is difficult technically to gain access to the lateral recess without extensive bone resection with conventional techniques when performed from within the spinal canal. Small curved endoscopes have been developed to assist the surgeon visualise this hidden corner. Unfortunately these endoscopes are not widely available and do not have the operating working channel to allow visualised clearance sufficiently laterally in the foramen. The wide dissection of conventional surgery carries an increased risk of scarring. This is avoided with the E.L.F.
Disc degeneration, settlement and “Instability” irritate and compress nerves in the lateral recess leading conventionally to an open fusion procedure with instrumented fusion. Fusion currently has a 30% dissatisfaction rate at 2 years and accelerates domino degeneration in the adjacent overloaded discs.
The Endoscopic Laser Foraminoplasty procedure opens the lateral recess, decompresses the nerve roots, accepts the settlement and allows continued micromovements at the segmental level. This is expected to avoid the acceleration of degeneration at the adjacent levels. It preserves all options for the patient for the future including “Keyhole” disc replacement, and “Keyhole” fusion as well as conventional fusion or Total Disc Replacement.
Using the Bloodless cut of the Holmium laser, the risk of scarring following this procedure is minimised.
Endoscopic Laser Foraminoplasty has been developed and now uses powered reamers, radiofrequency and endoscopes with larger working channels allowing more advanced degeneration to be treated. In its updated form the procedure is termed Endoscopic Laser Decompression & Foraminoplasty and can be used for the following:
- Narrow based disc protrusions, extrusions, sequestra
- Bone to bone settlement
- Lateral Recess Stenosis
- Axial (central) stenosis without excessive medial facet overgrowth
- Dynamic retrolisthesis or anterior olisthesis
- Perineural scarring
- Spondylolytic Spondylolisthesis
- Instability (Angular/Slippage)
- Failed Back Surgery Syndrome
- Chronic Pain Management
In this respect this technique is proving very exciting as it allows the scar to be resected and cut away from the nerve with the patient awake. The aware state protects the patient from injury to the nerve and improves diagnostic accuracy and targeting of precise source of the pain generator and its specific treatment.
Current studies indicate that Endoscopic Laser Decompression & Foraminoplasty offers patients an 80% chance of a “Good Clinical Impact” 2 – 4 years after treatment for Compressive Radiculopathy from disc protrusions, disc extrusions and sequestrations, (slipped discs), Back Pain, Non-Compressive Radiculopathy, Failed Back Syndrome, Failed Fusion Surgery, Perineural Scarring, Epidural Scarring, and Multilevel Degenerative Disc Disease, Osteophytosis, Disc Settlement, “Black” Disc syndrome, Lateral Recess Stenosis and Dynamic Olisthesis (“Instability”).
