Non Surgical Treatments
Transforaminal Endoscopic Fragmentectomy Discectomy
Transforaminal Endoscopic Discectomy (TFED) is a minimally invasive spine surgery technique that utilizes aendoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain
The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia
The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients’ leg and back pain.
Trans-foraminal Endoscopic Discectomy (TFED) is different because it is a visualized endoscopic surgical method (like knee arthroscopy) that is designed to visualize the patho-anatomy of the disc, spinal canal, and the adjacent nerves. We use special hand instruments to remove the herniated disc.
About the Procedure
Surgery time is approximately 45 minutes per disc. A small ¼ inch incision is made on the back to the side of the spine. Entry point is precisely calculated by fluoroscopic intra-operative measurements.
Sedation and local anesthesia is provided. The anesthetic will allow the patient to be comfortable during the procedure but will leave enough feeling in the nerves so the patient can actually tell when the nerve is being stimulated or when pressure is taken away from the nerve.
The instrument placement is performed under fluoroscopic guidance. A conical probe (obturator) with a side hole for palpating structures and for anesthetizing painful structures is used to dilate a path to the disc. After determining that the probe is in the safe triangular zone between the traversing and exiting spinal nerves, the disc is entered either by bluntly fenestrating the annular fibers with the probe or cutting the annulus with a trephine.
If there is an unusual amount of pain with the docking of the blunt probe on the annulus, the surgeon can opt to visualize the outer aspect of the disc before entering the disc. Anomalous nerves and branches of spinal and automonic nerves have been visualized and documented as contributing causes of back and leg pain that are currently not recognized by traditional surgeons.
The procedure proceeds by a cannula being passed over the blunt obturator followed by insertion of the endoscope and operating instruments. The two spinal nerves are protected by the cannula and only the part of the disc needing surgery will be exposed to the operating instruments.
The endoscope is inserted into the cannula and degenerated nucleus pulposus is visualized and selectively removed from the herniation site in the posterior portion of the disc. When treating annular tears a small amount of nuclear tissue is removed from underneath the tear. Often, some of this nuclear tissue is seen interposed within the tear preventing it from healing.
The procedure is performed in an day care setting and patients are usually discharged same or next day.