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.
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Mentions: Intraoperative PA and lateral discogram demonstrating a grade V annular tear (Figure 19A-E). Annular defect identified after removing the degenerative nucleus. The defect was visualized with a 70-degree scope. The nerve and dura was protected by an intact PLL between the annular defect and epidural space, shielding the nerve from chemical irritation. The tear would open and close with the patient's breathing. The nerve and epidural space was shielded by the PLL. Note mildly inflamed disc annulus and blue stained nucleus material (Figure 19F). Thermal modulation with a bipolar flex probe (using a biportal technique) ablated the inflammatory and disc tissue and partially contracted the hole in the annulus (Figure 19G). After thermal modulation, a valve-like flap would open and close the hole (Figure 19H). Discectomy specimen contained 4 grams of soft, degenerative nucleus pulposus. This patient remains asymptomatic after 5 years.
No MeSH data available.