If back and neck pain is affecting your quality of life and you have little relief with conservative treatments, it may be time to consider spine surgery. Spine surgery can now be performed in a minimally invasive manner using endoscopic techniques supported by advanced technology from joimax® for superior results. Fellowship-trained neurosurgeon Dr. Brian Hwang performs endoscopic spine surgery in Laguna Hills, California to treat conditions such as herniated discs, spinal stenosis and facet joint disease. Using the advanced joimax® technology increases precision while patients experience minimal tissue injury with quick recovery and good outcomes.
Endoscopic Spine Surgery for Herniated Disc
A herniated disc – what is it?
In the course of the normal aging process or by overload, cracks may appear in the fibrous ring. Part of the gelatinous core can be extruded through the anulus into the spinal canal and pinch or obstruct the nerves. This is what is meant by a herniated disc. Most herniated discs occur in the lower lumbar spine or at the connection to the sacrum.
What causes a herniated disc?
- Sudden rotational trunk movements or heavy lifting
- Monotonous routines (e.g. incorrect sitting)
- Weak abdominal or back muscles
- Dehydration and a poor diet
- Obesity and hereditary deformity
What are the most common symptoms of a herniated disc?
- Back pain with or without radiating pain into the legs or arms
- Paresthesia or even symptoms of paralysis
When is surgery necessary for a herniated disc?
Surgery is usually only necessary for a herniated disc if the pain does not lessen after at least 6 weeks of physiotherapy or muscle training and pain medication, or if there are symptoms of paralysis. In all cases, compression of the nerve roots is clearly identified as the cause
Endoscopic disc surgery in 3 steps
We believe that all patients deserve the very best surgical method – and it has to be as gentle as possible. The joimax® endoscopic methods were designed for that very reason. Dr. Hwang works with modern, technically sophisticated instruments and devices through a “keyhole“ approach. A small incision of a few millimeters is made and surrounding tissue is moved aside until the herniation is reached
Lateral Approach
1st step – Access
During surgery, you lie either on your side or stomach. Your surgeon will make an only millimeter-long dorsal incision in your back and create a channel directly to the herniated disc. Surrounding tissue is moved aside gently without cutting. A natural opening – the intervertebral foramen or the interlaminary fenestration – is used to access the vertebral canal.
2nd step – The herniation is removed
The surgeon guides a special endoscope through the keyhole to the surgical field and has a bright and sharp view of all structures in the spinal canal. The herniated disc material is carefully and gently removed by using tiny forceps and other special instruments.
3rd step – Review and completion
On completion, the surgeon will check that the affected nerve fibers are now moving freely. Only then will the instruments be removed and the small incision closed with one or two stitches and a dressing. You will usually be back on your feet after a few hours. Your doctor will decide when you are fit enough to go home and resume normal activities.
Endoscopic Spine Surgery for Spinal Stenosis
Spinal stenosis – what is it?
Under normal circumstances, there is sufficient space for the nerves in the spinal canal. If intervertebral discs, vertebrae or ligaments require more space due to aging developing degeneration, it results into narrowing or stenosis. This means the nerves may be squeezed or even pinched and pain or a loss of sensation may result. These are the symptoms of spinal canal stenosis or vertebral canal stenosis. This may affect your quality of life or restrict everyday activities. For example, a trip to town may no longer be possible, since walking and standing become unbearable.
What are the causes of spinal stenosis?
- Wear and tear as part of the normal aging process
- Congenital factors such as a hollow back, spondylolisthesis or malformation of the spine
What are the most common symptoms of spinal stenosis?
- Back pain worsening over the years and radiating to the legs
- Abnormal sensation and in severe cases a loss or strength in arms and/or legs
- Increased pain on standing or walking; bending forwards reduces the pain temporarily
When is surgery for spinal stenosis necessary?
The degree of pinching and the resulting pain indicate whether surgery is necessary. First conservative treatments are applied to the spine for pain relief, e.g. physiotherapy, muscle training or massage. Pain-relieving and anti-inflammatory medication can also help alleviate pain. If the symptoms have not lessened after at least 3 months of treatment, or the pain has increased significantly or the narrowing of the vertebral canal is advanced, than an operation is considered.
Endoscopic surgery for spinal stenosis – 3 steps to pain relief
If surgery is necessary, it should be as gentle as possible. With our advanced surgical procedure, the joimax® method, surgeons use modern, technically-sophisticated instruments and devices working through a “keyhole“ approach. An incision only a few millimeters long is made. The tissue is carefully moved aside; it is not dissected, so ligaments, muscles and bones remain intact. The risk of infection is also significantly lower.
1st step – Access
For access to the vertebral canal, a natural opening is utilized – either the intervertebral foramen or the interlaminar window. Diagnostic MRI and/or CT imaging allows selection of the best access route to the structures that are impinging the neural structures within the vertebral canal. Through the „keyhole“ approach, the surgeon creates a canal to the narrowing structures.
2nd step – The impinging tissue is removed
The “keyhole“ now allows different instruments to be inserted, for example, a diamond abrasor, to remove bony structures that are impinging the neural elements of the spine. By using a specialized endoscope, the surgeon has a fully illuminated and detailed view on all structures in the vertebral canal within a safe working environment.
3rd step – Review and completion
At the end of the operation, the surgeon will check if the affected neural elements are moving freely. At this point, all instruments are removed and the small incision is closed with one or two stitches and a dressing. You are usually back on your feet after a few hours. Your doctor will let you know when you can go home and return to normal activities
Advantages of Endoscopic Spine Surgery
- All the stabilizing structures of the spine – ligaments, muscles and bones remain virtually unaffected
- Minimal risk of infection
- Fewer scars, less wound and muscle pain
- Faster return to everyday life
