In general, it is widely accepted that back pain is related both to the ‘discs’ of soft tissue that separate and cushion the vertebrae in the spinal column, to the network of nerves which populate and surround the spinal area and to the joints at the back of the spine termed “facet joints”. Until the advent of aware state surgical examination however, the actual sources of back pain were hard to define and surgeons engaged in a certain amount of pre-operative ‘guesstimation’ based upon the results of clinical examination, X-rays, MRI scans and CAT scans.
Such is the complexity of the spinal region it is perhaps hardly surprising that a very large range of possible medical conditions exist to confound diagnosis. The spine is subjected to the stresses and strains of everyday living. In time the discs can become damaged and distorted, bone structures and facet joints can deteriorate or change, and nerves can be trapped, pinched or irritated. All are potential sources of back pain and some of these can cause problems that may lead to restricted mobility.
It is common for the spine to suffer from many areas of deterioration and strange nerve combinations. Aware state surgical examination enables the patient to give feedback to the surgeon, guiding him or her to the point in the spine that is responsible for the pain. This ‘live’ approach allows the causal level to be accurately defined and subsequently viewed using endoscopic instruments through a very tiny incision. In this way the exact cause of the pain can be detected and diagnostic errors avoided. Thus, the surgeon is guided to the precise source of pain at that specified inter-vertebral point.
Single targeted surgery enables the condition to be treated specifically and precisely with the minimum of collateral damage to tissues, reduced risk to the patient and enhanced long-term outcome. This treatment, which is called ‘Foraminoplasty’ because it is carried out in the gaps or ‘Foramen’ between the vertebrae, is only made possible by the use of Endoscopic Minimally Invasive Spine Surgery.
Conventional multi-level open surgery including microdiscectomy, open decompression, solid or flexible fusion and disc replacement is an ‘overkill’ with such negative side-effects as blood loss, potential nerve and tissue damage, extended post-operative care and unnecessarily operating on pain-free levels. Also, it is not as effective as Foraminoplasty in addressing and ameliorating back pain and scarring around nerves. Other minimalist procedures using the posterior, anterior or lateral approaches also fail to address the entrapment of the nerve in the foramen and its copious sources of pain. Conventional techniques run the risk of increased complications including recurrent disc bulging, infection, nerve damage and scarring round the nerve, implant failure, major vessel damage or sexual dysfunction.
