Frequently Asked Questions

What is Minimally Invasive Spine Surgery?
What is Laser Spine Surgery?
What is Endoscopic Spine Surgery?
What is Percutaneous Disc Decompression?
What is Nucleoplasty?
What is IDET?
What is Annuloplasty?
What is Facet Rhizotomy?
What is Radiofrequency Nerve Ablation (RFNA)?
What is the Difference Between and Orthopaedic Spine Surgeon and a Neurosurgeon?

1. What is Minimally Invasive Spine Surgery?
Minimally invasive spine (MIS) surgery is not one specific technique, but instead includes a variety of surgical procedures that are performed through much smaller incisions than traditional spine surgery. Specialized instruments are used to perform the surgery through small tubes or portals, allowing for minimal disruption of the surrounding anatomy.

The benefits of minimally invasive spine surgery include:

Small incisions and minimal scar tissue formation
Less damage to surrounding muscle and soft tissues
Decreased blood loss
Decreased pain and reduced need for pain medication
Quicker recovery and faster return to regular activities
Shorter hospital stays
Many procedures can be performed as outpatient surgery
Decreased risk of postoperative infection

2. What is Laser Spine Surgery?
The term “Laser Spine Sugery” does not describe one specific technique. The laser is merely a tool that can be used to perform specific surgical techniques that may (or may not) help with back and leg pain. A laser is a device that produces a form of light energy. Surgical lasers are typically used to remove (ablate) unwanted or abnormal tissue. As the affected tissues absorb the laser, light is converted to heat. As the tissue is heated, it vaporizes, a process known as ablation. The laser is not a “magic wand” that can reverse arthritis, heal degenerated discs, or cure all back pain.

Click here to learn more about laser spine surgery.

3. What is Endoscopic Spine Surgery?
Endoscopic spine surgery is a minimally-invasive spine procedure. An endoscope is a very thin fiber-optic video camera, which can be used to see internal portions of the body. The camera sends the images to a monitor similar to a television. The endoscope is made with built-in magnification and a light source. Surgery is performed by passing instruments through the endoscope to remove disc material or bone spurs. The major advantage of the endoscope is that it allows for the procedure to be done through a very small incision with minimal tissue damage, while allowing direct visualization of the desired anatomy via the camera.

Endoscopes used for spine surgery are typically the diameter of a standard pencil (5-7mm). The endoscope is inserted into the body through a small “keyhole” incision, just large enough for the endoscope to fit through. When this technique is used, the procedure is considered to be true endoscopic surgery.

The endoscope can also be inserted through an “open” incision or through a tubular retractor in order to improve visualization with greater magnification of anatomic structures. This technique is called “endoscopically-assisted” surgery and is often done through slightly larger incisions (14-18mm) than true endoscopic surgery.

The benefits of endoscopic spine surgery as compared to traditional “open” surgery include:

Small incisions and minimal scar tissue formation
Less damage to surrounding muscle and soft tissues
Decreased blood loss
Decreased pain and reduced need for pain medication
Quicker recovery and faster return to regular activities
Procedures can be performed as outpatient surgery
Decreased risk of postoperative infection

Click here to learn more about endoscopic spine surgery.

4. What is Percutaneous Disc Decompression?
Percutaneous disc decompression is different than endoscopic spine surgery. It is a procedure done to treat small disc bulges, also called contained disc herniations. A contained disc herniation means that the inner gel (nucleus) has not penetrated the outer wall of the disc into the spinal canal. Percuataneous disc decompression is not indicated for complete (extruded) disc herniations where the nucleus has fully-penetrated the outer wall.

Percutaneous is a term that literally means “through the skin”. Percutaneous surgery involves procedures that are performed through tiny incisions or punctures in the skin without the surgeon having a direct view of the anatomy that he or she is working on. Since the surgeon cannot see the instruments beneath the skin, the surgeon has to use a portable x-ray machine (fluoroscope) to see where the surgical instruments are located within the body.

Percutaneous disc decompression involves placing a long needle into the disc and passing some type of instrument through the needle to remove small channels of disc material from within the disc. The instrument may be a mechanical device, laser or other tool. The theory behind this treatment is that by removing disc material from within the disc, pressure on the outer wall is relieved, reducing the symptoms caused by the disc bulge.

Although the concept of treating herniated discs with these procedures is attractive, the results have not been as good as what was hoped. Percutaneous disc decompression techniques do not allow for direct visualization of the disc herniation, nerve root, or other anatomy. Because of this, it is very difficult for the surgeon to selectively remove the portion of disc that is directly pressing on the nerve without injuring the nerve. Therefore, percutaneous techniques are non-selective, meaning that disc material is removed from within the disc, but the disc protrusion or herniation itself is often not necessarily removed directly from the nerve. Also, percutaneous discectomy is only indicated for small, contained herniations, which will typically respond to non-surgical treatment, including therapy, medications, and epidural steroid injections. Because these results of percutaneous discectomy are less satisfactory than those achieved with other techniques, these procedures have largely fallen out of favor.

Percutaneous disc decompression procedures also go by the names:

Dekompressor Discectomy
Nucleotome Discectomy
LASE procedure
Percutaneous Laser Disc Decompression
Percutaneous Laser Discoplasty
Percutaneous Disc Nucleoplasty®
Plasma Disc Decompression

5. What is Nucleoplasty?
Nucleoplasty® (also called plasma disc decompression) is a surgical technique developed by a company called Arthrocare. It is one form of Percutaneous Disc Decompression (see above).
Percutaneous disc decompression involves placing a long needle into the disc and passing some type of instrument through the needle to remove small channels of disc material from within the disc. In the case of Nucleoplasty®, the instrument ablates (removes) disc material with a proprietary technology called Coblation® which dissolves the disc material at a lower temperature than a laser. The theory behind percutaneous disc decompression is that by removing disc material from within the disc, pressure on the outer wall is relieved, reducing the symptoms caused by the disc bulge.

Percutaneous disc decompression techniques do not allow for direct visualization of the disc herniation, nerve root, or other anatomy. Because of this, it is very difficult for the surgeon to selectively remove the portion of disc that is directly pressing on the nerve without injuring the nerve. Therefore, percutaneous techniques are non-selective, meaning that disc material is removed from within the disc, but the disc protrusion or herniation itself is often not necessarily removed directly from the nerve. Also, percutaneous discectomy is only indicated for small, contained herniations, which will typically respond to non-surgical treatment, including therapy, medications, and epidural steroid injections. Because these results of percutaneous discectomy are less satisfactory than those achieved with other techniques, these procedures have largely fallen out of favor.

6. What is IDET?
Intradiscal electrothermal therapy, or IDET, (also called annuloplasty) is a procedure used to treat back pain from mild or moderate degenerative disc disease. Tears in the outer wall (annulus) of the lumbar disc are treated with heat in an attempt to deaden nerves and seal the tears in order to reduce back pain.

During an intradiscal electrothermal annuloplasty, a probe (electrothermal catheter) is inserted into the patient’s affected disc. Once inside, the probe is slowly heated to 90 degrees Celsius (194 degrees Fahrenheit). The heat shrinks and thickens the disc wall’s collagen fibers to assist in the closing of the tear. Nerve endings within the disc are then cauterized (burned) to help block pain signals.

Studies have shown that IDET only has about a 50-60% success rate. Also, the healing process takes time, and relief of pain typically takes at least six weeks following IDET, and strenuous activities should be avoided for 5-6 months.

It is important to note that weakened discs also may lead to a bulging disc (contained disc herniation) or ruptured disc (extruded disc herniation), and IDET is not indicated for these conditions. Likewise, severe degenerative disc disease requires more extensive treatment than IDET can provide.

Other names for IDET include:

Annuloplasty
Disc Biacuplasty

7. What is Annuloplasty?
Annuloplasty is another term for IDET (see above)

8. What is Facet Rhizotomy?
Facet rhizotomy (nerve ablation) is a procedure done to treat back pain or neck pain caused by painful facet joints. The word rhizotomy means “nerve destruction” or nerve ablation. In facet rhizotomy, the tiny nerve fibers that carry pain signals from the facet joints to the brain are selectively destroyed using some form of energy.

The cause of facet joint pain is often not well understood, but in some cases is thought to be due to arthritic or inflamed joints. In many patients with back or neck pain, it can be difficult to determine whether the pain is coming from the discs, the joints, other tissues, or a combination of these structures. Prior to performing a rhizotomy, facet joint injections are performed to relieve inflammation and pain and to determine if the pain is actually coming from the facet joints. The effects of the facet injections are temporary – providing relief that can last for days to years. The goal is to reduce pain so that you can return to normal activities and participate in a physical therapy program to strengthen your spine.

For patients who have had successful, but temporary relief of their back or neck pain from the facet injections, facet rhizotomy may provide more long-term relief.

Facet rhizotomy is most commonly performed using a form of energy called radiofrequency (RF) energy. When done with RF, this technique is often called radiofrequency nerve ablation (RFNA). RF uses an electromagnetic energy field with very high frequency radio waves (400,000 cycles per second). RF uses the radio wave energy through the tiny tip of an insulated needle (a probe). The doctor can apply the right amount of energy to "cook" a specific nerve without destroying the surrounding tissue. Facet rhizotomy can also be performed with laser energy (Laser Facet Rhizotomy).

Rhizotomy temporarily turns off the nerve's ability to transmit pain signals to the brain. With time, the nerve will regenerate, but in the meantime, you'll most likely have pain relief. Pain relief ranges from 9 months to 3 years. Most patients have around 1 year of pain relief after rhizotomy.
Facet rhizotomy can be performed as part of endoscopic spine surgery or as a non-surgical procedure, and may be performed by a spine surgeon, a non-operative spine physician called a physiatrist, or by an anesthesia pain specialist.

9. What is Radiofrequency Nerve Ablation (RFNA)?
Radiofrequency nerve ablation (RFNA) is the most commonly performed type of facet joint rhizotomy (see above).

10. What’s the Difference Between an Orthopaedic Spine Surgeon and a Neurosurgeon?

Orthopaedic spine surgeons and neurosurgeons are equally qualified to perform most types of spine surgery. Both perform cervical, thoracic, and lumbar surgery, including spinal cord and nerve decompression, spinal fusion, microsurgery and minimally-invasive spine surgery.

Both types of surgeons complete four years of medical school before entering a residency in their specific field. Traditionally, orthopaedic surgeons complete five years of residency training in the diagnosis and treatment of all musculoskeletal (bone, joint, muscle and nerve) disorders including those of the spine, whereas neurosurgeons complete residency training in disorders of the brain and spine. Many spine surgeons will complete additional training in spine surgery after their residency called a fellowship. A fellowship involves more specialized training in advanced spinal surgery techniques including spinal fusion, minimally invasive spine surgery, and complex spinal reconstruction.

For the most part, the qualifications of the surgeon to do spine surgery are more driven by the amount of training in spine surgery and the amount of the surgeon's practice devoted to spine surgery rather than by whether or not the surgeon is a neurosurgeon or orthopaedic surgeon.

Questions to ask about your spine surgeon:

Is the spine surgeon fellowship trained in spine surgery?
Is the spine surgeon part of a multidisciplinary spine center?
Is the spine surgeon trained in microsurgery and other minimally invasive techniques?
Is spine surgery a big part of the surgeon's practice, or is he or she more of a general orthopaedic surgeon or neurosurgeon?

Questions to ask yourself after seeing your spine surgeon:

Did the surgeon fully explain the diagnosis and cause of your pain?
Do you feel comfortable with the surgeon and feel that all of your questions have been fully addressed?
Did the surgeon offer a full range of treatment choices or immediately discuss surgical treatment?