At a Glance:
1. What is Full Endoscopic Spine Surgery (FESS)?
2. What are the conditions treated with Full Endoscopic Spine Surgery (FESS)?
3. What are the common endoscopic spine surgery treatment options?
4. Who are suitable candidates for Full Endoscopic Spine Surgery (FESS)?
5. What are the benefits of Full Endoscopic Spine Surgery (FESS)?
6. Is Full Endoscopic Spine Surgery (FESS) safe – what are the risks?
7. Recovery after Full Endoscopic Spine Surgery (FESS), how long does it take?
8. How should one choose a facility for Full Endoscopic Spine Surgery (FESS)?
Full Endoscopic Spine Surgery (FESS) is the least invasive and very effective surgical technique to treat sliped or prolapsed disc.
Minimally invasive spine surgery (MISS) is a surgical procedure for the backbone or the bones of the spine. The term “minimally invasive” signifies that the surgery is carried out using much smaller cuts or incisions as compared to the standard, open surgery where the incisions are typically long, and go down the back. Surgery of the spine is often recommended as a second line of treatment for back problems once the more conservative approaches, i.e. medications or physical therapy fail to bring about the desired outcomes.
Open surgery is more traumatic not only due to the size of the incision but also because there is considerable harm to the nearby tissues and muscles as they need to be moved away for visualization of the surgical field and instrumentation. On the contrary, because of the reduced trauma to the muscles and soft tissues due to a smaller incision, minimally invasive surgical procedure is faster, safer and has a reduced recovery time.
While in some cases, the size of incision primarily defines whether surgery is minimally invasive, in such a case MISS may only be a description of the incision whereas the actual surgical procedure may still be the same. In a majority of cases of “minimally invasive” techniques a series of tubes known as “tubular retractors”, going from smaller to larger are used to stretch and retract the soft tissues for the surgical exposure.
The size of the tubular retractor is governed by two factors:
The size of the tubular retractor, in turn, determines the size of the incision or the extent of invasiveness. Usually, the smaller the diameter of the tube, the lesser invasive is the procedure, but more is the skill required to perform the procedure.
Minimally invasive surgery is recommended in certain cases of degenerative discs, fractures and herniated disc kyphosis, infection, scoliosis and spinal column tumours. Some of the commonly performed minimally invasive spine surgery procedures are:
At present, “Endoscopic spine surgery” (ESS) is the least invasive spine surgery which is performed with the smallest tubes in the range of 3mm –10mm for different procedures and an incision of few millimetres. Endoscopic spine surgery is performed with a tube fitted with a high definition camera that allows the surgeon to get to and visualize the pathology without causing much collateral damage to surrounding tissues. Since the light source is located at the tip of the instrument, the need to shine a light from the access point is eliminated, creating an opportunity to reduce the size of the tube.
Endoscopic spine surgery may be suitable for a large number of painful conditions of the spine. Some of the commonly treated conditions using endoscopic techniques are:
In most cases, the major goals of the surgery are to relieve the affected nerve root from pressure or irritation or to interrupt the pain sensations from the sensory nerves.
Today, the endoscopic technique may be applied for many types of spine surgery with faster recovery time and fewer risks of developing complications. The undermentioned procedures are performed commonly:
Transforaminal endoscopic procedures
Interlaminar endoscopic procedures
Endoscopic posterior foraminotomy and cervical discectomy to relieve pressure on compressed nerve and remove affected disc
Endoscopic visualized rhizotomy to sever nerve roots in the spinal cord
One of the most important steps to successful endoscopic spine surgery is an appropriate diagnosis.Even though many candidates for endoscopic spine surgery have common types of spinal disorders like facet arthropathy, moderate to severe disc herniation, sciatica, and spinal stenosis, spine surgery is not always considered to be the first line of treatment. Non-surgical options like spinal injections and physical therapy is considered before any type of spine surgery is advised.
Some of the variables that influence successful surgical outcomes include:
Smallest possible incisions and hyper-targeting of the surgical site causes less trauma to the adjacent structures like skin, muscle, and soft tissues and most ESS procedures take about one hour to perform. This has many benefits like:
Just like any other surgical procedure, ESS is not devoid of risks and there are general risks and procedure-specific risks. Some of the general risks of spine surgery include the risk of:
The procedure-specific risks of ESS include the risk of:
A person could expect a long recovery, as much as a year in some cases until a few years ago. However, with the advancements in minimally invasive surgery techniques, especially endoscopic spine surgery, the overall recovery period has been reduced to a few days or less with a few small scars at the site of the incision.
Since the majority of the ESS procedures are done on an outpatient basis, a person can expect to go home the same day. Depending on the overall health, after the procedure a person will be made to stay for a couple of hours or a day or two for observation. While there may be some amount of pain after the surgery, it can be relieved with pain medications prescribed by the treating surgeon.
A person can resume a normal diet as soon as you one can.
The spine surgeon advices instructions about the usage of the back after the surgery. Some of these maybe
The overall recovery time of a person may vary depending on the type of surgery and general health. However, one can resume normal activities within a few weeks.
For a quicker and safer recovery and successful surgery, one should ensure adherence to the spine surgeon’s instructions about treatment and follow-up appointments.
Most important nerves of the body’s functioning originate from the spine, making it a very vulnerable site for open surgical procedures. One of the main objectives of the endoscopic spine surgery is to avoid collateral damage to the adjacent tissues. This objective can be achieved by a precise diagnosis, sophisticated equipment, and spine surgical expertise which is usually not available collectively at most of the healthcare settings. Hence the treatment facility is available only at a few select super-speciality hospitals of India.
The decision to have spine surgery is an important one that needs to be seriously taken collectively by the affected person, family and the spine surgeon. Finding the right facility and surgeon to perform endoscopic spine surgery is paramount in a successful surgery and also to ensure that the person is comfortable with the decision to have surgery.
Some of the reasons for the rarity of spine surgery experts specializing in endoscopic spine surgery are:
Endoscopic spine surgery is a highly specialized technique that should not be confused with other types of minimally invasive or laser spine surgeries. The endoscopic spine surgery is performed using tubular retractors and the endoscope with a high definition camera, making it the least invasive of all surgical procedures of the spine. In the hands of a highly skilled and experienced spine surgeon, the potential benefits of this extremely advanced version of minimally invasive surgery promises relief to many persons living with chronic back and neck pain.
ESS has many potential benefits, including:
Generally, people leading an active, healthy lifestyle are the most suitable candidates for endoscopic spine surgery. However, a spine surgeon should be consulted for an opinion on suitability to undergo the procedure even in people who are not in the best of health.
Despite its benefits, ESS may not be a suitable option for all conditions of the spine such as scoliosis, spinal instability, cancer, or trauma where a traditional open or minimally invasive spine surgery may be a better option.
For more information please request a call-back and our health experts will get in touch with you.
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