Micro-spine-surgery and MISS Who really does this?

[ubedqubmiewikaeab]

I was wondering if anyone knew of places that really did this kind of surgery? A really minimal incision and micro-surgery tools? There seems to be so much rivalry in this area throughout the UK and the USA.

And who has had successful results with it?

thanks

Cassie

 

[lostprof]

Great questions, thanks.

Best place in UK for this type of surgery is Spinal Foundation, founded by famous dr. Martin Knight. Other great places are Wooridul Spine Hospital (Korea, dr. Sang-Ho Lee and his team), Desert Institute for Spine Care (USA, dr. Anthony Yeung), dr. Thomas Hoogland (Germany, I think he sometimes operates in Beta Klinik Bonn), dr. Robert saftic (Croatia, Spine Surgery Croatia).

Its not a myth. If you don't wait for surgery too long, if you had no previous surgery on affected level, minimally-invasive spine surgery (especially endoscopic and laser) can have from 80-90% success rate. Not only in one center. This has been scientifically proven.

I know a lot (and I really mean A LOT) of patients that had great results with laser spine surgery (PLDD). My mother had endoscopic surgery for her failed back surgery syndrome, at it relieved only 20% of her pains (understandable considering the fact that she already had one open surgery).

Don't ever compare micro and minimally. Micro-surgery and minimally-invasive surgery are two different terms that mean different concept in spine surgery.

Your note about rivalry is in place. Biggest "enemies" of minimally-invasive spine surgery are surgeons that:
1. Are not prepared to move on,
2. Don't want to follow advances in modern medicine,
3. They think "its something new", although MISS is around for 20-30 years,
4. Don't have the ability to perform this technically advanced surgeries

I personally know more than 10 spine surgeons. Some of them do MISS, some of them only traditional surgeries... and I tell all this from my personal experience.

If you have more questions, please ask.

 

[invitemeforcoffee.co.uk]

I know I've said this before but when using statements like 'x is the best' it's helpful - sometimes necessary - to qualify that statement. Given that judging quality of even straightforward things is a complex matter with many variables, it would be nice to know your criteria. Providing this would also teach us all more about the subject.

Not just to do full service to the patient who may be going under the knife, it's also necessary to be fair to the many providers in the market who may have valid differences of opinion over many aspects of care. I do not really accept that these variations are entirely to do with those who see the light vs those who don't.

Lastly, is this a completely impartial view that you offer or do you have a vested interest?

 

[queenbk04]

1. If your "x is the best" relates to my note about "The Spinal Foundation", then I suggest that you look at dr. Knights method, CV and history. When you do this, it will all be clear for you. I have nothing more to add on this.

2. You see, you mention knife. In this surgeries I talk about, knife is HISTORY. I am open to discussion with people who work in field of traditional spine surgery. I am open to share facts and studies that show advantages of MISS.

3. My interest is only the patient benefit, thats it.

 

[lilharibo]

Why nothing more to add, this is your big opportunity to tell us what you think in greater depth? You seem to have a strong view on this, are you really basing it on one surgeon's own website? Forgive the English expression - under the knife is a loose term for having surgery. The point I was making, however, is that there are differences of opinion in everything, it's not always right versus wrong, if only it were that simple. Hence please give the background to your views, it would add a lot to my understanding of the issues. We all care about the patient, I take it from your last point that you have no actual connection with Dr Knight or his clinic, have I read this right?

 

[soby H]

I have been told certain things from forum owners (admins and moderators), that is why I don't want to write more information about dr. Knight or SF. I have told enough to make all fellow spine patients interested in MISS. Patients need to know that most of them have better alternative available, and this is point of my writing.

My view is not based on SF website. Its based on:
1. Personal "first hand" experience
2. Personal research
3. Partly on my job (I am working on a charity project strongly related to spinal medicine)

You are right, its not always simple and its not always "right versus wrong". In spinal medicine, there are a lot of conditions that can be treated only by traditional methods, there are some conditions that may have better outcomes with traditional methods, but most of this can be more successfully treated by MISS.

And to repeat once again, I am not connected to dr. Knight and I am not connected to any of UK surgeons.

 

[Cee & Kay <3]

So what about the Microspine Institute? Laser Spine? Bonati? I am in two minds as to whether the UK are doing it the right way by probing nerves to see if they illicit the right response under sedation and causing a 3- 3 and a half hour operation, versus the way many USA doctors do two days of pre-operation diagnostic tests using injected nerve block to see which are, where, which nerve etc is causing the symptoms, and then having a shorter 1 hour operation with no potentially irritated nerves to contend with later on that may cause a two week flare up post-op?

It actually makes physically probing, prodding or touching the actual nerves seem rather barbaric especially because it means a longer period on the operating table for the patient under sedation and then a recovery period for the actual nerves themselves?

 

[Zakonye]

What is your diagnosis?

 

[Gudgebobuniob]

I have a bad back, lol What do you think about the probing versus blocks?

 

[latenotnever]

Sometimes booth is necessary to evaluate the case and indicate the surgery (especially for FBSS).

Nerve blocks will tell nothing if nerves themselves are not source of your pain. That is why spinal probing (e.g. discography) is ordered. There are several other blocks and infiltrations that can be used as therapeutic/diagnostic method like sympatetic block, intraforaminal block, intradiscal steroid injection, radio-frequency ablation, etc.

Some doctors and organizations state that discography causes further disc degeneration and that may really be true, but discography is very valuable method in patients with no visible problem on MRI or CT.

 

[Brown Eyes]

Keano, what is your opinion of the TESSYS technique for endoscopic spinal surgery? I'm asking this because I just read about it after reviewing the profile of a surgeon with whom I might be having a consult. How does it differ to the endoscopic technique already discussed in this thread and what are the pros and cons in comparison?

 

[majeed3245]

But TESSYS is not a technique, its a endoscopic system by Joimax.
Its very similar to Richard Wolf endoscopic system and tools.

With TESSYS system, surgeons can achieve same things like with other systems. It has all advantages of minimally-invasive spinal surgery that I already mentioned few times.

All best

 

[afzaal]

Thanks Keano.
On the Joinmax website, they suggest that their high frequency radiowaves method is safer than laser for example. Quote : "preserves healthy tissue and protect vital structures". Is this based on any evidence or just a bit of hype?

 

[blueprint101]

You have to disconnect two things:
1. Laser/RF used inside the disc for decompression (dr. Choy's method from 1980's)
2. Laser/RF used to seal the the disc during endoscopic surgery or ablate abnormal disc tissue during endoscopic surgery

During endoscopic surgery, some surgeons use RF to (like dr. Yeung, dr. Saftic and many others). However, some of them use laser (AFAIK dr. Knight).

I will quote dr. Anthony Yeung:
"Thermal annuloplasty is an adjunctive procedure that uses bipolar electro-thermal energy (radiofrequency and/or laser) to ablate or depopulate the sensitized pain nociceptors in the annulus, ablate any inflammatory/grannualtion tissue that has grown into the annulus, and to shrink and tighten the stretched or torn collagen fibers of the annulus."

I have seen this in action during real surgery and watched all on monitor. Its wonderful technique, and by applying laser/RF (depending on surgeon and tehnique) they decrease chance of re-herniation.

Regards...

 

[Butgrenered]

Thanks Keano.

A thorough response as ever.

all the best.

 

[huevzumlijxijsexg]

Heck yes!! Thank-you Keano.

Now Jim.... who is the possible consult with please

 

[Anti_Vatican]

Hi Cassie, well I wouldn't like to mention individuals by name on a forum, but if you want I can PM you the details

 

[yzeaiuzfiajixuedq]

Another question I have come across, so I wonder if anyone can help me out with this please?

Why don't surgeons offer endoscopic surgery in a MISS way but on more than one side level in one operation? So they would be making more than one incision and working on more than one level/side, perhaps with the patient asleep, but use the endoscope and laser so as not to have to remove a chunk of lamina as in the traditional open back laminectomy? It is pretty obvious on some mri's what needs to be done so for instance 3 or even 4 eldf's by endoscopic MISS at one go, or maybe 2 say but why only one at a time?

Is it time? because the patient has to be awake during the use of the laser or endoscope? I just don't want to have 4 operations ( 2 levels, both sides) I want one operation and a MISS one, isn't that possible?

 

[Joe racing]

For example, on second world congress of minimally-invasive spinal surgery and techniques (WCMISST 2) doctor Saftic presented his work and case study of a multi-level less invasive foraminotomy for spondilotic lumbar stenosis.

It depends on the surgeon and each case individually of course.

I don't think that the time is an issue. I think its all about the surgeon.

 

[Aleksey]

Thank-you In that case I will keep on pursuing it, I can see that the cost must have a lot to do with it too? But there must be a way to combine MISS with multilevels. I also understand that surgeons often say that they need to see the results of the one op before going on to the next one. In the USA thery will combine a cervical op with a lumbar, but not two lumbar?