The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature.
Bottom Line: It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy.This has also resulted in better pre surgical planning with more specific and defined goals in mind.The "Inside out" philosophy of TFE surgery is safe and precise.
Affiliation: Prime Surgical Centre, Pune, India.
Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize "pain" generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The "Inside out" philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies.
No MeSH data available.
Related in: MedlinePlus
Mentions: Currently available equipment include high resolution rod lens operating endoscopes, beveled cannulas, trephine, endoscopic kerrison, bipolar RF electrode, straight and side firing Holmium-YAG laser, and a high speed diamond and articulated based burr. Each tool has a unique role in performing special surgical tasks with various sized access cannulas and scopes. Recent addition of a hook and flexible curette which can extend reach to epidural area and migrated fragments makes removal of those fragments easier and possible at times without removal of bone. The addition of a curette helps in cutting the tip of the superior articular process (SAP) to expose the hidden zone and deroof and decompress the DRG and axilla of the root in the lateral canal. A curette is seen on the SAP of the facet in Figure 7.
No MeSH data available.