endoscopic discectomy

[Extralong]

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Anyone doing those? I just came back from ASIPP and this lecturer discussed doing them on a regular bases. I know the MILD procedure fell by the wayside along with vertebroplasty/kyphoplasty. Thoughts on endoscopic discectomy?

-E

 

[Aether2000]

I used to do them both transformational and inter laminar approaches using several different systems with 3-7mm wide cannulas. I even taught a course at ASIPP on this in the past. My suggestion is that you don't do them because they effectively decompress the nucleus displacing axial forces onto the annulus, can reach the inspissated fragment of disc herniation embedded in the wall of the annulus only via inter laminar approach, and have no better outcomes than traditional discectomy. The procedure does not work for annular tear repair and degeneration of the discs.

 

[Extralong]

I used to do them both transformational and inter laminar approaches using several different systems with 3-7mm wide cannulas. I even taught a course at ASIPP on this in the past. My suggestion is that you don't do them because they effectively decompress the nucleus displacing axial forces onto the annulus, can reach the inspissated fragment of disc herniation embedded in the wall of the annulus only via inter laminar approach, and have no better outcomes than traditional discectomy. The procedure does not work for annular tear repair and degeneration of the discs.

Thanks!
Is there a difference in complications(post-op and at followup) between the two?

 

[Aether2000]

Depends on aggressiveness. The interlaminar approach has the same complication rate as microdiscectomy. Transforaminal is less but leaves the fragment in the annulus. Nerve complications are minimized using an oval shped cannula end or with an extension (tang) on the cannula tip.

 

[epidural man]

Anyone doing those? I just came back from ASIPP and this lecturer discussed doing them on a regular bases. I know the MILD procedure fell by the wayside along with vertebroplasty/kyphoplasty. Thoughts on endoscopic discectomy?

-E

I just read somewhere - maybe in pain news - about a newer procedure that is treating the ligament and facets - similar to MILD.

It looked interesting.

 

[BobBarker]

Kypho may not be done as frequently as in the past, but it still done routinely.

 

[emd123]

Kypho may not be done as frequently as in the past, but it still done routinely.

Agree. When did kypho supposedly die?

 

[Extralong]

kypho died about 2.75 years ago, i think. Though I know a few people that still advocate for it.

 

[emd123]

kypho died about 2.75 years ago, i think. Though I know a few people that still advocate for it.

It works. There's been studies on both sides. Still covered by Medicare. In fact, the coverage for in office, is the best thing we've got, by a mile.

 

[miamidoc2b]

algos - what is the indication for endo disc?