Endoscopic Minimal Invasive Spine Surgery - Lower Back

Endoscopes are a form of medical telescopes – small tubes with the means of letting the surgeon visualise the surgical target through a tiny hole of 2 – 7 mm with great magnification.   The benefits are truly minimal disturbance of muscles and tissues, reduced collateral damage and unwanted scarring, all resulting in enhanced rehabilitation and clinical outcomes. The techniques are more technically demanding and require specific training of the surgeon.

The spine can be approached endoscopically from the front (anterior), side (lateral or transforaminal) or back (posterior). This page focuses upon the promising advantages of the transforaminal techniques.  The anterior and lateral approaches facilitate the conventional anterior intervertebral fusion whilst the posterior approach is used to facilitate conventional discectomy or decompression and suffers from access limitation within the disc or through the foramen (the doorway by which nerves leave the spine to reach the body and limbs).

Transforaminal Techniques

Based upon a personal experience of over 7,500 interventions since 1990 Martin Knight considers the transforaminal approach provides great versatility for current and evolving techniques.  This approach allows the surgeon to approach the spine, its contents and discs through the side door of the spine thus limiting risk to the structures such as nerves in the spinal canal itself.

In so doing it allows the treatment of a wide range of conditions causing back pain or leg pain (Sciatica) such as:

  • Slipped discs (disc protrusions or extrusions), 
  • Nerve compression and spinal narrowing (axial and lateral recess stenosis), 
  • Claudication, 
  • Leaking Discs or High Intensity Zones (Black Disc Syndrome),
  • Leg pain (Sciatica), 
  • Spinal “instability”, 
  • Vertebral slippage (spondylolytic spondylolisthesis or degenerative spondylolisthesis),  
  • Degenerative Scoliosis,
  • Arachnoiditis,
  • Failed Back Surgery, 
  • Failed Fusion Surgery
  • Failed Total Disc Replacement Surgery.

Using aware state surgery, with potent sedation and powerful circulating pain control, you the patient lead us surgeons precisely to the source of your pain and avoid the need for conventional large interventions such as Microdiscectomies (Microscope driven discectomies), (Posterior) Interlaminar Decompressions, Interspinous Spacers, Intervertebral Instrumented Fusions and Total Disc Replacements. 

Specific minimalist laser or radiofrequency enhanced techniques can be applied at multiple levels through a single small (2-7mm) incision to treat each pain source in the lower spine as a “Day Case or Overnight Stay” procedure with accelerated rehabilitation and longstanding benefits.

80% of all the complex cases passing through our multi-disciplinary group are satisfied with their outcome when reviewed 2 years after surgery and 69% at 10 years.

The incidence of complications is significantly reduced - for instance we have had only 9 infections and 7 dural tears in the 7,800* neck and lumbar interventions.

By contrast this technique allows you the patient to take us to the source of your pain and show us what is hurting you and guide us to alleviate the problem precisely.

Because there is no general anaesthetic these techniques can be used in all age groups as well as in those patients with diabetes mellitus, cardiac arrhythmias, cardiac disease, cerebral dysfunction (strokes), pulmonary dysfunction (emphysema), previous venous thrombosis, multiple sclerosis, Parkinsonism etc.

*Data from Martin Knight’s team

Content provided by Martin Knight, Consultant Orthopaedic and Spinal Surgeon, Fawkham Manor Hospital

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