ENDOSCOPIC BACK SURGERY GIVES PATIENTS SAME DAY RECOVERY

New Surgical Technique Breaks Medical Ground
As It Decompresses & Repairs Damaged Disks Without Open Surgery

By Jerome Cleary

BEVERLY HILLS, CA - Marking a major development in back surgery procedures, Neurosurgeon, David Ditsworth, M.D., has created a revolutionary small endoscopic discectomy that decompresses and repairs damaged discs in the back without exposing the spine. Dr. Ditsworth spent the last ten years perfecting his new technique and designing the pioneering medical equipment necessary to perform this virtually closed spine surgery."

It is effective, low risk, and allows for a faster return to work and to daily activities. Patients are discharged the same day with just a band-aid," remarks Ditsworth. This procedure that is done on an outpatient basis, is now available to patients at Beverly Hills Doctors Surgery Center on Spalding Drive in Beverly Hills.

Whereas endoscopic techniques used in other areas of the body have become commonplace, spinal endoscopic techniques have developed slowly. This is because of the complex anatomy inherent in the spine and because of the lack of equipment designed specifically for spinal endoscopy. Working space within the spine is confined deep within the body, with access to pathology hampered by the bony structures and the presence of soft tissue, epidural vessels, nerve roots, and dura. All of these obstacles are overcome by Ditsworth's specialized medical equipment and targeted technique.

"Ditsworth's superb technological approach effectively dispels most of my previous criticism of the numerous so-called minimally invasive procedures," remarks Dr. Charles Fager, professor of Neurosurgery, Harvard Medical School and author of Atlas of Spinal Surgery. "This is the back surgery of the future," says Dr. Stewart Dunsker, Professor and Director of Spine Surgery, University of Cincinnati and the President of the American Association of Neurological Surgeons. "This is the treatment neurosurgeons use for disc disease," says, Dr. James I. Ausman, M.D., Ph.D., and Editor of Surgical Neurology.

The endoscopic discectomy procedure takes an hour on average. Patients normally will feel little discomfort. There are no stitches. Upon completion, a small adhesive bandage is placed over the opening which is usually no larger than the size of a freckle. The amount of nucleus tissue removed varies, but the supporting structure of the disc is not affected by Ditsworth's technique.

"Many people with chronic back pain are suffering too much for too long and need more advanced treatment," says Dr. Ditsworth. Despite treatment,back pain, and related sciatic pain is at an all time high. Research from The Orthopedic Clinic of North America reveals these alarming statistics for many traditional back surgeries in the United States: 25,000-50,000 failed back surgery syndrome cases are reported each year; overall failure rate 30 percent (fusion), 37.3 (non-fusion), re-operation rate 6.9 percent overall at two-year follow-up; 11.9 percent (fusion), 10.2 percent (non-fusion) at four-year follow-up; re-hospitalization 22.4 percent (fusion), 18.3 percent (non-fusion).

"Low back pain is the most prevalent cause of disability in people under age 45, and of the $27 billion spent on all musculoskeletal trauma $16 billion is spent in the management of low back pain, more than half of that $16 billion being spent on surgical treatment. Low back pain is one of the most frequent problems treated by orthopaedic surgeons. Four out of five adults will experience significant low back pain sometime during their life. After the common cold, problems caused by the lower back are the most frequent cause of lost work days in adults under the age of 45," according to Amy Hendel, Health Expert, R-PAC and host of TV's Doctors On Call.

An extra industry has sprung up to help back pain patients cope with their spinal issues, stores such as Relax Your Back and websites such as americanspine.com, spineonline.com, and Holland-spine.com that account for the $27 billion national medical expense annually. Back pain is the price human beings pay for poor posture, prolonged sitting, repeated bending, and other stresses placed on the lower back. The nucleus tissue can be placed under so much pressure that it can cause the annulus to herniate or rupture. In most cases, simple treatments such as bed rest, physical therapy, exercise, and pain medication bring relief. However, many are not so fortunate.

The Procedure: Using local anesthesia with the help of x-ray fluoroscopy and magnified video for guidance, Ditsworth's small, specially designed endoscope is inserted through the skin of the back, between the vertebrae and into the herniated disc space. Tiny surgical instruments are then sent down the hollow center of the endoscope probe to remove a portion of the offending disc. The microsurgical instruments can also sometimes be used to push the bulging disc back into place and be used for the removal of disc fragments and small bony spurs.

Endoscopic Discectomy is different from open lumbar disc surgery because there is no traumatic back muscle dissection, no bone removal, or large skin incision. The risk of complications from scarring, blood loss, infection, and anesthesia that may occur with conventional surgery is drastically reduced or eliminated with this procedure. According to Dr. Ditsworth, this is the safest procedure to treat a ruptured disc without a spinal block (anesthesing your body from the waist down). General anesthesia has many risks, which include, using a ventilator to help the patient breath not on their own, therefore putting the patient on total dependence on the anestheologist. According to Ditsworth, there are many risks of open spine surgery. "It is a certainty with open operations that you will have a substantial scar, not only visible on the skin's surface, but everywhere the operation is done. When you are talking about working near nerve roots where the herniated discs are, you do not want extensive dissection, cutting and exploring, which is done, in every open operation. While some patients who have open surgery tolerate it, many patients are going to suffer permanent ill effects from the open surgery. When open surgery is done it traumatizes the patient. Patients who are in poor health and with medical conditions such as: obesity, hypertension, heart problems, HIV, immune disorders, and old age are actually the prime candidates," remarks,Dr. Ditsworth.

The advantages of Endoscopic Discectomy are many: it is effective and very low risk; there is no scarring in or around the nerves or on the surface. Because the Endoscopic Discectomy procedure is performed on an outpatient basis, you may be allowed to return home the day of the procedure. Many patients worldwide fly in for the procedure and fly out the next day.

Background of spinal problems: Lumbar Discs are the structures, which serve as shock absorbers between the vertebrae of the spinal column. The center of the disc, called the nucleus, is soft and springy and accepts the shock of standing, walking, running, etc. The outer part, called the annulus is comprised of a series of interwoven layers of fibrous tissues, which hold the nucleus in place. Back Pain, and related sciatic pain is the price human beings pay for poor posture, prolonged sitting, repeated bending, and other stresses placed on the lower back. The nucleus tissue can be placed under so much pressure that it can cause the annulus to herniate or rupture. In most cases, simple treatments such as bed rest, physical therapy, exercise, and pain medication bring relief. However, many sufferers are not so fortunate. When a disc is herniated, it may create pressure against one or more of the spinal nerves, which may cause severe pain, numbness, or weakness in the low back, legs and/or feet.

Ditsworth's Research: There are many causes of low back pain, some of these typically are: degenerative joint disease, disk disease, spinal stenosis, spondylolisthesis, and osteoporosis with compression fracture. Over a two and a half year period, Ditsworth performed endoscopic discectomies on 25 patients with L5-S1 free fragments. They underwent outpatient using a small soft, malleable scope technique, which is not traumatic to the spinal canal contents. The 25 patients ranged in age from 29 to 61, 15 males and 10 females. All had free fragments in the spinal canal at L5-S1 (the lowest disc level) ruptured lateral to the dura. Open microdiscectomy had already been recommended in all cases. All had radicular pain, numbness and/or weakness for at least six weeks consistent with the herniation.

Ditsworth's Results: (Macnab1 criteria): 22 excellent (no symptoms, no restriction of activity) 2 good (occasional symptoms), 1 poor (no improvement, required further surgery); for an overall success rate of 96%. Ditsworth's technique provides the ultimate advantage because the actual endoscope itself can be placed directly into the free fragment for optimal visualization and removal, in the most direct, least traumatic approach for reaching and removing free fragments at L5-S1.

Recent patient surgeries: Ex-professional hockey star Brian Hayward recently had the Ditsworth surgery in July 2002 and made a full recovery. This was after years of other orthopedic surgeons telling him that he would have to live with the pain, since any back surgery was too risky. Today Hayward is well known as the on-air correspondent for ESPN, Fox Sports and the Canadian Broadcast corp. Heather Schwartz, a 26-year old patient had the surgery this past May 2002, before the surgery she was unable to walk and was in severe pain. Today she walks only with a slight limp and has made a full recovery.

Dr. David Ditsworth had been published in Surgical Neurology:Endoscopic Transforaminal Lumbar Discectomy and Reconfiguration :A Posterolateral Approach into the Spinal Canal Surgical Neurology [An International Journal : 1998 Jun; 49(6):588-97;]

1 According to Dr. MacNab, who developed the evaluation MacNab criteria to give results of back surgery.