4. Reaming to enlarge the foramen
for placement of working channel,
or treating spinal stenosis at the foramen.
5. Insertion of endoscope to begin removing the
herniated disc material identified by the blue indigo carmine dye.
3. Performance of Tissue Dilation
2. Performance of Discography
1. Identifying the surgical site.
TED or Transforaminal Endoscopic Discectomy is performed in an outpatient surgical center licensed by AHCA, and CMS, state and federal licensing agencies. The procedure is divided into the following components
1. Needle placement for entering the spinal canal performed under local anesthesia and IV sedation with Versed and Fentanyl.
2. Discography and Chromography which identifies the damaged disc under x-ray fluoroscopy and colors the disc for easy visualization during endoscopic surgery
3. Entering the soft tissues with Tissue dilators performed under local anesthesia and IV sedation with Versed and Fentanyl.
4. Expanding the canal neuroforamina opening with reamers when it is determined to be necessary, performed under local anesthesia and IV sedation with Versed and Fentanyl.
5. Placement of "working channel" for endoscope and performance of disc removal or remodeling the bones to open the foramen to take the pressure off of the nerve.
6. Performance of nucleoplasty to assist with prevention of further herniation, and performance of a selective nerve root block with steroids to impede nerve root swelling and minimize post operative discomfort.
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6. From this point forward surgery is performed
using the direct vision endoscope to manipulate
the instruments. Position and depth are monitored on the fluoroscope. The patient communicates directly with the surgeon and follows commands for leg and spine movement. The patient can communicate when nerve pressure is present and released. In addition to a variety of graspers, high speed drills and hand held reamers with chisels may be employed to remove osteophytes and improve the direct vision for the surgeon. A constant flow of low pressure fluid with antibiotics cleans the surgical debris and maintains visibility. At the conclusion of the surgery steroids are passed into the working channel to decrease post operative swelling and pain.
The incision is the size of your small fingernail width.
Postoperatively, a back brace is worn for 4 weeks. Back strengthening program with MedX is initiated on Week 5 and continues for 12 sessions.