Depending on the area of the spine we are referring to, advanced spinal endoscopy can be performed using different types of approaches.

• Lumbar spine endoscopy: It is the lowest part of the spine. The most common pathologies in this area are lumbar disc herniation and lumbar canal stenosis.
• Advanced endoscopy of the thoracic or dorsal spine: This area is located between the beginning of the spinal cord and ends at the coccyx. The most common pathologies are back pain and hypomobility of the spine.
• Spine endoscopy cervical: It is the upper part of the spine, close to the neck. Cervical pain or cervical disc herniations are the types of pathologies most commonly operated on using minimally invasive endoscopic surgery.

With spinal endoscopy we can mill or drill all the bone structures that compress the exit of the nerves, both the sheets of the spinal canal and the foramen through which they exit.

There are numerous pathologies and diseases of the spine that can be treated through endoscopy, such as lumbar and cervical disc herniation or canal stenosis. 

The first phase of the spine surgery requires about 30 minutes approximately. The steps to follow will be the following:

• The patient is anesthetized (in most cases general anesthesia).
• The positioning of the patient for this surgery must be precise: prone position with padding on the chest and pelvic region, and tilting in flexion of the lower extremities.
• Anteroposterior and lateral views are used to accurately identify the approach and entrance of the endoscopic optical camera.

The second surgical phase of endoscopy It usually lasts around 45 minutes:

• Once the level to be treated has been radiologically identified, an incision of a few millimeters is made in the skin.
• Once inside the spinal canal, the compressed root is separated to remove the herniated fragment. It is essential to ensure complete root release by exploring the nerve path and examining the interior of the disc.
• Subsequently, in certain cases the stem cells will be implanted.

The total duration of advanced spinal endoscopy It is usually 75 minutes.

Some advantages of advanced spinal endoscopy compared to conventional techniques such as open surgery (which are also used for lumbar disc herniation treatment and other pathologies) are the following:

• Quick recovery after endoscopic surgery.
• Endoscopy provides a high-definition view that cannot be obtained with the naked eye or microscope.
• The incision in the skin is just a few millimeters long.
• The damage to the tissues and the risk of complications are minimal and, therefore, postoperative pain is reduced. Leaving the hospital is almost immediate after the intervention.
• It allows the treatment of pathologies in both the spinal canal and the foraminal-extraforaminal.
• Lower risk of degenerative complications and spinal instability that may require more aggressive surgeries such as interbody arthrodesis (screws and bars).
• Reduces bleeding compared to open surgery or microdiscectomy.
• Lower risk of infections thanks to the minimal incision made in advanced spinal endoscopy.

The previous study is essential and must be composed of the following complementary tests: lateral, anteroposterior and functional x-rays in maximum extension and flexion of the lumbar spine, magnetic resonance imaging and a neurophysiological study with electromyoneurogram.

The patient must have maintained the symptoms resulting from compression of lumbar disc herniation or canal stenosis without significant relief with anti-inflammatories, analgesics or antineuritic drugs.

Sometimes, the symptoms are so intense that the patient cannot bear the pain and earlier surgery is necessary.

Two or three days before surgery it is preferable not to take anti-inflammatories and only follow a treatment with analgesics to avoid the antiplatelet effect. This protocol is not essential, but less bleeding is achieved during surgery and therefore less coagulation of the bleeding points.

At our Institute of Advanced Spine Surgery, the case of suffering from a herniated disc is added to the advanced spinal endoscopy stem cell implantation concentrated, one of the most advanced and innovative treatments in biological research.

Our mission is not only to relieve the patient's pain with endoscopic herniated disc removal that compressed the nerve or the space of the neurological structures. Furthermore, with the stem cell treatment we get the complete intervertebral disc regeneration and recover its function, to avoid degeneration of the disc and vertebral joints.

The cellular differentiation of stem cells increases vascularization and peridiscal innervation, improving the diffusion of nutrients to the components of the disc that have been partially removed or damaged: the nucleus pulposus and the annulus fibrosus.

The Stem cells are extracted from the iliac crest of the pelvis of the patient, through a minimum percutaneous incision of 3 mm and puncture/aspiration with a fine needle that is inserted inside the bone.

After extraction, a specific centrifugation is performed in the laboratory and a concentrate of cells is obtained that is introduced into the area of the operated disc with endoscopy as a guide.. It is performed during endoscopic surgery in which the hernia has been removed or the neurological structures of the spinal canal or foraminal have been decompressed.

With this advanced spine surgery technique, a improvement of low back pain and, in many cases, a regeneration of the intervertebral disc.

Upon discharge from the hospital, the patient must receive the medical report specifying the surgical findings and the technique used.

In relation to post-surgical medication, anti-inflammatories – analgesics are used in the first days as required. Generally, one analgesic drug is usually sufficient, although it is better to complement the report with two alternates in case it is necessary. The Muscle relaxants are only used in case of lumbar contracture.

The surgical wound is about 0.5 cm in the back or side of the lumbar region. A stitch or staple is usually given. We can wash the wound from the 5th day onwards, keeping it clean and dry with betadine or chlorhexidine dressings. There are usually no complications of infection or wound openings due to its small size. With endoscopic surgery, continuous washing is performed through the endoscopic optics, so the risk of infection is minimal.

Lumbar support is not required and after the first 15 days physical activity can be increased. From the first day, it is advisable to movements of the thoracolumbar spine without excessive energy: flexion-extension, lateralizations and rotations. Bad posture or handling of heavy loads should be avoided in the first month.

If there is any lumbar discomfort due to muscle contracture, in relation to the surgical posture, we can apply local heat for 20 minutes 3-4 times a day and perform progressive stretching exercises.

If residual lumbar pain persists, the exercises can be complemented with a physical rehabilitation session. It is always advisable to go hand in hand with the best spine traumatologists in Madrid to avoid going back.

Driving the car can be done immediately in the first days, although it is recommended to use a cushion the first few days to avoid increasing abdominal and intervertebral disc tension.

In case of any complication or incident, consult the emergency service of the hospital where you underwent surgery.

The recovery after endoscopic spine surgery It is very quick since the skin incision is only 1 cm and drainage placement is not necessary.

The pain disappears immediately after surgery. Sometimes, if the nerves have been compressed for a long time or intensely, tingling (paresthesias) or swelling (hypoesthesias) occurs which progressively disappears in a few weeks.

The patient is discharged from the hospital on the same day of the operation once he or she recovers from surgical anesthesia. Support and walking begin immediately and crutches or a wheelchair are not required when returning home. Daily activity is recovered during the first week and, if you practice sports, this is resumed after the sixth week.

It is worth highlighting the importance of avoiding intense physical efforts before the third month, but physical progression helps early recovery. Furthermore, exercising moderately will always be positive.

The wound is so small that it does not require intensive care. It is simply kept clean and dry until the first check-up, 7-10 hours after the operation, where the first dressing is performed and the stitch is removed.

It is essential to maintain the back and abdominal muscles with good muscle tone. Stretching exercises that improve dorsolumbar elasticity or strengthening exercises should be performed periodically to have a structured back and avoid discomfort and relapses.

Maintaining a good weight and healthy habits (smoking or eating) help avoid back pain.

The results studied in the short and medium term are very good without requiring, in most cases, revisions or new spinal surgeries due to complications having arisen.

With the implantation of stem cells in the damaged intervertebral disc Its clinical improvement and its prevention in evolutionary degeneration of the spine are studied.

Control is usually done in consultation in the first 15 days after surgery and a month later.

If a stem cell implantation, the reviews are annual to see the evolution of improvement of the intervertebral disc on magnetic resonance imaging.