The source of Sciatica can be clearly defined by aware state surgical examination. Patient feedback guides the surgeon to the point in the lumbar spine responsible for the pain. Pre-operative guesstimation by clinical examination, X-rays and MRI scans or CAT scans is rendered obsolete. This “live” approach allows the causal level to be defined immediately or by Differential Discography and then visualised endoscopically. Thus neural anomalies and strange nerve combinations can be detected and diagnostic errors avoided. Subsequent endoscopic examination with the patient awake then leads the surgeon to the precise source of the pain at that specified intervertebral level. This can then be treated specifically and precisely with the minimum of collateral damage to tissues, reduced risk to the patient and enhanced long-term outcome.
Above all the use of “overkill” multi-level surgery can be avoided and single targeted surgery appropriately deployed. Only transforaminal endoscopic surgery can perform effective total foraminal clearance and treatment (Foraminoplasty) and provide treatment for back pain, buttock and sciatica. Minimalist procedures using the posterior, anterior or lateral approaches fail to address the foramen and its copious sources of pain effectively.
These pain sources are inadequately treated by non-foraminal procedures such as microdiscectomy, open decompression, solid or flexible fusion, Total Disc Replacement or interspinous spacers with the consequence that clinical benefit is limited. Endoscopic Minimally Invasive Spine Surgery does address these pain sources and consequently achieves high rates of amelioration of back, buttock and sciatica. It acts as a filter protecting patients from the more dangerous complication prone open procedures. If it fails to provide sufficient relief of Sciatica then the more risk prone procedures can still be employed and because the foramen has been cleared, the results of the traditional techniques may thereby be enhanced. The use of minimalist techniques now may allow time for more innovative minimalist techniques to come on stream.
The treatment of Back pain, Buttock pain and Sciatica by Endoscopic Minimally Invasive Spine Surgery through the foramen and together with endoscopic discectomy provides an effective means of treating the myriad of causes of Sciatica because they usually arise from a distortion of the nerve or a malfunction of the foramen and its contained structures. Thus these techniques can treat Sciatica arising from disc protrusion, extrusion, sequestration, lateral recess stenosis, Spondylolytic Spondylolisthesis, anterior olisthesis (slippage), retrolisthesis, settlement, instability, facet joint disease, and some forms of axial (central) stenosis, discitis, osteophytosis, degenerative scoliosis, radial tears etc.
