ENDOSCOPIC LUMBAR AND CERVICAL
SPINAL STENOSIS SURGERY

The goal of spinal stenosis surgery is to relieve the pressure on the spinal cord and nerve tissues caused by spinal stenosis. Removing the pressure on the nerves allows them to function normally to aid in relieving pain, numbness, loss of strength as well as various other symptoms related to the pressure of the affected nerve and surrounding tissues. The pressure on the nerve tissues is mainly caused by the thickening of the ligaments in the spine and, to a lesser extent, by calcification of the bone tissue.

With the advancement of technology and the addition of new hand tools to endoscopic spine surgery sets, the ability to perform endoscopic surgeries has increased considerably. Thanks to high-speed bone shaver motors, endoscopic techniques are widely used in narrow canals in the spine, narrowing in the holes (foramen) where the nerve roots exit and narrowing of the lateral recesses. These operations, which were previously regarded as long and complicated surgeries with excessive bleeding using traditional methods, can now be performed endoscopically in a short time with less risk, minimal bleeding and a much shorter recovery period. Endoscopic lumbar and cervical spinal stenosis surgeries can be performed under general or spinal anesthesia (with a lumbar injection).

Currently, this surgery can be performed on the lower back, neck and back.

Endoscopic lumbar and cervical spinal stenosis surgery is performed using one of two different techniques: (1) the monoportal and (2) the biportal endoscopic (UBE surgery) techniques.

In the monoportal technique, similar to the fully endoscopic hernia surgery, after the location of the diseased area in the spine is determined using a scopy device (special X-ray machine), the surgeon enters through a single hole and inserts an endoscope through the cannula. With the help of hand tools and a high-speed bone shaver, the motors are passed through the endoscope and the narrow canal and nerve roots in the spine are decompressed.

In the biportal (UBE surgery) technique, a camera is inserted through a small hole of 5 mm in length at the appropriate point. Subsequently, surgical instruments are advanced through the second 7 mm hole. The problematic sections in the narrow spinal canal are expanded with the help of an endoscope (camera) and the spinal cord and nerve roots are decompressed.

Because no incision is made in the muscle tissue in endoscopic surgery, there is much less pain after surgery, hence, less need for pain reducers. There is minimal bleeding during the procedure, so there is no blood transfusion required. Since the patient’s bone and muscle tissue are not damaged during the procedure, there is no need to put screws and platinum. Since it is a procedure that protects soft tissue, the patient can walk the same day after surgery. Endoscopic lumbar and cervical spinal canal stenosis surgeries, much like knee or shoulder arthroscopic surgeries, are performed in an aqueous environment in order to provide a clear camera image. Since the operation site is continuously washed during the operation due to the use of water, infection rates are lower than those in open surgery.

Traditional open surgery involves aggressive removal of the bone and other connective tissues causing the pressure that is responsible for the patient’s pain. There is also a need for the use of screw systems, commonly known as platinum. The use of these systems is actually unnecessary in most patients. Since closed surgery does not damage normal structures and joints in the spine, these screw systems are largely unnecessary. In rare cases, if there is instability accompanying spinal canal stenosis or if there is a risk that the tissues removed during surgery will damage the biomechanics of the spine, reduce the stability of the spine, and/or cause slippage in the spine, it may be necessary to support the bones with special materials to make the spine stronger. In these cases, these screw systems can also be performed endoscopically through 4 1.5 cm incisions without damaging surrounding tissues and muscles.

ADVANTAGES OF ENDOSCOPIC SURGERY OVER OPEN SURGERY

• Healthy tissues are not cut unnecessarily
• There is minimal amount of bleeding
• There is very little risk of infection
• There is a short recovery time post surgery
• In the postoperative period, less amount of pain medication is needed and for a shorter period of time
• There is a much shorter hospital stay
• The patient can return to normal life much sooner
• Certain endoscopic surgeries can be performed under local anesthesia, without the need for general anesthesia
• Screws and rod systems are generally not needed

WHAT IS THE LENGTH OF THE OPERATION?

The length of an endoscopic spinal stenosis surgery is approximately one hour. However, this time can be longer if there is a narrowing of the spinal canal at more than one level.

WHAT IS THE SUCCESS RATE OF THE OPERATION?

Endoscopic surgery for spinal stenosis often has very satisfactory results. The vast majority of patients benefit significantly from the surgery. After the operation, there is a substantial improvement in the patient’s quality of life.

WHEN CAN YOU STAND UP AFTER SURGERY?

After the effect of the postoperative anesthesia wears off, patients can stand up, walk and go to the be able to go to the restroom. It is recommended that they be accompanied by an attendant initially, but can soon be able to return to their usual daily activities soon after surgery.

IS THERE PAIN AFTER SURGERY?

Since this surgery is performed using two small incisions of only half a centimeter each, and there are no incisions made to the surrounding soft tissue muscle, pain is considerably less in this surgical technique, especially when compared to other traditional surgical methods.

WHEN WILL YOU BE DISCHARGED AFTER SURGERY?

In most cases, patients can be discharged from the hospital after several hours post-surgery, on the same day.

WHEN CAN PATIENTS SHOWER AFTER SURGERY?

Especially if waterproof wound closures are used at the incision sites, patients can take a shower immediately after being discharged.

WHAT SHOULD BE CONSIDERED AFTER SURGERY?

After endoscopic spinal stenosis surgery, there are no significant physical or postural restrictions as there are no screw and rod systems placed. However, in order to avoid nerve edema, we recommend restraining from long walks or strenuous activities for 1 week to 10 days.

Since the patient does not have a very large wound, dressing should be done on the 3rd and 5th days after being discharged. Since the wound is closed with aesthetic sutures, there is no need for postoperative stitch removal.

WHEN CAN YOU RETURN TO WORK AFTER SURGERY?

For those who work in the office, patients may return to work 5-7 days after the surgery. For those whose work requires heavy physical labor, we could recommend resting for up to 4 weeks depending on the patient’s specific case.

WHAT ARE THE RISKS OF SURGERY?

The main and most feared risk of spinal stenosis surgery is spinal cord or nerve damage, which, although rare, can occur during surgery. There are also risks dural tear, bleeding and infection although this surgical technique aims to anticipate and minimize these risks. In endoscopic surgery, these risks are even lower when performed by an experienced surgeon in this field, especially compared to traditional open surgery, as the tissues can be seen 40 times larger than normal and the operation is performed in an aqueous environment.