Research About Minimally Invasive Spine Procedures

Many groups that talk about minimally invasive procedures have little to no clinical research to back up their claims. The minimally invasive spine surgery experts working with North American Spine practice the most conservative, least invasive medicine possible to achieve superior results.

They use an evidence-based approach that is specially tailored to the symptoms and pathology of each individual patient and treatment options range from epidural steroid injections, to AccuraScope procedures all the way up to minimally invasive fusions and even open back surgeries in situations where that is what the patient needs. Independent, peer-reviewed research is a cornerstone of evidence-based medicine.

This page contains links to such articles and is updated as new research is published.

Cost-Effectiveness of Endoscopic Disc and Neural Decompression

Journal of Neurosurgical Review
Marian V. Ambramova, Erich O. Richter, and Kenneth M. Alo

Back pain is a major medical problem in the United States and work side, with a substantial economic impact. Previous reports from multiple centers have suggested that operative treatment may be superior to best medical management in selected patients, and that minimally invasive techniques may offer advantages over open surgical techniques in some situations. Due to the high cost of surgical intervention, it is important to assess the potential economic impact of alterative treatment strategies. In this study we surveyed patients who had undergone endoscopic discectomy and neural decompression (EDND) to determine self-reported costs of low back pain related medical care, and looked for differences between patients who had undergone previous back surgery and those who had not. One hundred patients who had undergone EDND in 2010-11 after at least 12 months of conservative care were selected randomly and asked to complete a questionnaire by telephone or on the internet. Histories of low back pain related medical care were collected and outcome was assessed with visual analogue scores (VAS) and the Oswestry Disability Index (ODI). Two year direct medical costs were estimated with Medicare allowable payment amounts. Eighty-three patients agreed to participate, 37 had had previous spine surgery. VAS declined 44% and ODI 48% after surgery, medical appointments declined by 65%. Sixty one percent reported a decrease in pain medication usage. Direct medical costs associated with low back pain averaged $6,821 the year prior to surgery, and $3,783 the year after, with no significant difference between the patients with previous back surgery and those without. These results indicate that by self-report, EDND is effective at alleviating low back pain and associated disability, and has a favorable economic impact on selected patients.

Anterior epiduroscopic neural decompression: Eight-center experience
in 154 patients

European Journal of Pain Supplements
Authors: Erich O. Richter, Marina V. Abramova, Frnando Cantu, Jose DeAndres, Peter Lierz, PierLuigi Manchiaro, Jean-Pierre Van Buyten, Jae-Do Kim, Jae-Ho Jang, Gu-Hee Jung, Ji-Youn Kim, Su-Jin Jang, Hector Salgado, Peter Salgado, Kenneth M. Alo

In recent years, technical advances have allowed more significant structural spine surgery through small access portals. Minimally invasive spinal surgery (MISS) is commonly thought of as posterior approaches using muscle dilating tubular retraction systems, but these approaches are best suited to a single spinal level and require bony disruption at each level treated. Access through the sacral hiatus with a flexible endoscope allows an alternative, longitudinal approach to the entire lumbar epidural space. Surgical instruments can be introduced through the endoscope, including laser waveguide fibers. In this article, we expand upon previous reports and describe the combined clinical results of endoscopic laser decompression in 154 patients from 8 centers. All cases of anterior endoscopic neural decompression via sacral laminotomy between December 2009 and May 2011 were reviewed at participating centers and sent a follow-up questionnaire. One hundred and fifty-four cases were identified. There was a significant improvement in disability caused by low-back and/or leg pain as measured by the RMQ. The postoperative level of pain improved from 7.5 to 3.4. By the MacNab scale, success was achieved in 82%. Overall, the patients demonstrated significant clinical recovery and improvement in both quality of life and overall pain levels. 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

Current Trends in Minimally Invasive Spinal Surgery

Journal of Neurosurgical Review
Authors: Erich O. Richter, Marina V. Abramova, & Jason C. Mussell

The past 30 years has seen a dramatic expansion in the technologies available to practitioners of interventional pain management for the spine. This survey article spans the historical development from spinal decompression and fixation techniques to the most recent endoscopic and laser based therapies. This review is based on the six basic mechanisms for reducing pain of spinal origin: 1) anti-inflammatory/analgesic; 2) lysis of scar/de-tethering; 3) decompression; 4) arthrodesis/fixation; 5) neural ablation; and 6) neuromodulation. Multiple therapeutic modalities are summarized in each of these domains including; intradiscal electrothermy, epiduroscopy with laser ablation, percutaneous or endoscopic instrumentation and arthrodesis, vertebral augmentation, interspinous process decompression, percutaneous removal of the ligamentum flavum, intrathecal medication infusion, and spinal cord or peripheral nerve, neuromodulation. Intracranial pain techniques are beyond the scope of this article. Each technique is addressed from the standpoints of basic concepts and anatomy, as well as efficacy and complications.

Epiduroscopic Laser Disc and Neural Decompression

Journal of Neurosurgical Review
Authors: Jae-Do Kim, Jae-Ho Jang, Gu-Hee Jung, Ji-Youn Kim & Su-Jin Jang

This study sought to evaluate the effectiveness of epiduroscopic disc and neural decompression with laser to epiduroscopic neural decompression alone, among patients with chronic refractory low-back and/or leg pain. A total of 109 patients with chronic low-back and/or leg pain were operated on epiduroscopically, with or without the addition of laser-based disc and neural decompression. Eleven patients were excluded because they had not yet met the minimum 6-month follow-up period criterion. The clinical outcomes of 20 epiduroscopic neural decompression (END) patients, and 78 epiduroscopic laser disc and neural decompression (ELND) patients were evaluated during a follow-up period. Outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, the Roland Morris Disability Questionnaire (RMDQ), and Mac Nab criteria. Among END patients, the mean back and/or leg pain VAS score improved from 8.5 to 4.6 one month after the operation. For ELND patients, the mean back and/or leg pain VAS score improved from 7.6 to 4.9 one month after the operation. The long-term END follow-up patients reported mean back and/or leg pain VAS score change from the initial 8.5 to 6.1, and for ELND patients from the initial 7.6 to 3.6. Mean RMDQ scores improved from 11.3 to 9.6 with END, and from 18.8 to 11.4 with ELND during the 1-month follow-up period. However, in the long-term follow-up data, the mean RMDQ score worsened from initial means of 11.3 to 11.4 for END patients but continued to improve from the one month mean of 11.4 to 10.6 for ELND. Results using the Mac Nab criteria were positive in 82% of the ELND group compared to 45% with the END group.Eighty-two percent of the patients treated with ELND (laser disc and neural decompression) reported positive treatment results as opposed to 45% receiving END alone (non laser neural decompression). Thus ELND, with its considerably higher percentage of positive outcomes, is judged to be a more effective therapeutic modality for patients with chronic refractory LBP.

Minimally Invasive Lumbar Decompression for Spinal Stenosis

Journal of Neurosurgical Review
Authors: Timothy R. Deer, Nagy Mekhail, Gabriel Lopez, & Kasra Amirdelfan

Over 1.2 million patients are diagnosed with, and in active treatment for lumbar spinal stenosis (LSS) at any given time. Typically, these patients experience discomfort while walking or standing, for any length of time. The LSS treatment algorithm contains a gap of under-treated patients between epidural steroid injections (ESI) and open surgery. With the introduction of a minimally invasive lumbar decompression, or mild®, procedure (Vertos Medical) for spinal stenosis, the LSS patient no longer needs to suffer under-treatment or undergo major lumbar surgery. mild® makes it is possible to address this progressive disease with a progressive option.


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