Extremely insightful. I have had 3 consults now and this procedure was just brought up today. I didn’t know how to ask questions on it but now this context has really cleared up things.
The quality of this video is excellent. The way you can stand next to the images and point your opaque hand directly to the specific anatomy is very impressive.
Thanks so much! Glad it helped. Stay tuned for more videos -- I am trying to make a comprehensive library specifically aimed at helping spine surgeons in training and early practice. And tell all your coresidents and friends! ;-)
You can do it bilaterally. It amounts to twice the dissection, twice the muscle trauma and twice the time so it usually becomes slower than anterior appproaches that are midline and afford access to both sides. It's not that it can't be done -- it just becomes a less competitive option compared to the anterior approaches. Also, the pain generators for neck pain are usually not nerve-root related and this procedure is specifically targeted at decompressing the nerve. The surgery itself involves more muscle dissection and "trauma" so it can sometimes contribute to neck pain. Hope that helps, -SP
Thank you for such an informative video. In the infrequent case of re-herniation following this procedure, is ADR still an option to restore loss of disc space and preserve motion. & if so, what artificial disc do you typically use in practice?
Great question. In the absence of instability on flexion extension xrays, and provided there are no other contraindications to ADR i think it would be a very reasonable option. I usually use Mobi-C but I don't think there's a strong advantage; depends more on your surgeons experience and comfort I would say. thanks! -SP
Excellent presentation. I have already cervical server central canal narrowing from c2-c5 due to ossification.Doctor said , surgery is the only option. But I have not server gaits or numbness in hand or leg. Mild pain only on neck. Is it necessary for a surgery doctor??. I am so worried about this matter because I have already so many other issues like subclavian artery blockages 70, diabetic and acid reflux and sleep apnea etc. could you please give me an opinion in this issue??. Australia
Thanks for watching. It is difficult to give you specific guidance as I am unable to examine you, review your imaging, etc. The decision-making should take many things into consideration that I don't have access to. I'm afraid I have to defer to the surgeon who saw you but it is always reasonable to get multiple opinions to reach a decision that you are comfortable with. Good luck! -SP
Great presentation! I have this exact issue and my doc in Stuart Florida wants to do an Acdf probably because it’s easier and he’s trained for it. He’s actually kinda young and should know more procedures so I guess I’ll have to find another doctor. Thanks again as an informed patient is the best patient.
Can you please make a video on Endoscopic Diskectomy vs MLD … I personally don’t see any difference between these two techniques, obviously it depends on personal choice and expertise. Need to listen from an expert like you. By the way very nice presentation on spine problems, I follow your channel carefully. Thanks from India.
Can this be used to treat a failed C5-C6 ACDF? The area has gone crazy with calcifications building up & is now flattening the spinal cord again. The calcification build-up is similar to your first herniated disc image, just bone not disc.
@@prasadspineacademy Thank you. Recent MRI showed some other issues: ligamentum flavum buckling at every cervical level, Heterogeneous fatty marrow changes, thecal sac stenosis, (at C5-C6) severe left foraminal stenosis, and advanced right foraminal stenosis.
I have a a slightly herniated C5. Arm pain and numbness and shoulder pain. That’s my main issue. I feel like I’m a good candidate for surgery. It’s only on 1 side my left and I have full range of motion Tried everything for 10yrs and can’t unpinch that nerve. If I lift weights even light weight it tightens up. I’m looking into this procedure. Thanks
If it's unilateral and your symptoms are from C4-5 foraminal stenosis and C5 radiculopathy then this may be a good option. Depending on your specific imaging and preferences foraminotomy, ACDF or anterior cervical disk replacement may all be reasonable considerations. Good luck! -SP
@@prasadspineacademyI’m debating between doing anterior Vs posterior on my C5/C6. I had an offer to do laser anterior by Dr Duek and an offer to do posterior from another Dr. Mork. Dr Mork is very reputable and he said it should work ok from back. If you do anterior do you still need a laminatomy? I just worry about instability or reherniation from laminotomy I’d rather go from back as raw as not dealing with cutting it leave scarring from neck in front
Hello sir. Nice presentation.What about just a Narrowing Foramen from Hypertrophy of articular process and small disc bulge, can do something just for foramen , like Foraminotomy but Lateral approach ? Just I ask because I saw here on youtube the intervention, but with lateral approach. Is it more complex, because of the complexity anatomy on the lateral ,or why you present just the Posterior approach? Is the posterior approach more ease to see and clean the foramen stenosis, with out damage the nerve, compare with lateral approach? But this posterior approach with laminoforaminotomy eliminate the lamina bon or part of it, this don't destabilize the vertebra, In the future, there can be no problems with the vertebra? What is the risk lateral compare with posterior Foraminotomy? Thank you.
Thanks for your question. I am not sure what you mean by "lateral approach". I do not know anyone that uses a purely lateral approach for the cervical spine. There are anterior foraminotomies that spare the bulk of the disk and there are variants on the posterior approach described here (endoscopic, tubular, etc). These involve removal of part of the lamina and medial joint to relieve pressure on the nerve. It is not considered to be significantly destabilizing. Good luck! -SP
@@prasadspineacademy Lateral I know sure , some surgeons do it from lateral side, not from posterior, what cause more damage to the patient. Why you need to cut to many things? Lateral insert the guidance close to the foramen and do all what is needed, with out cut lamina or something else.Is more easy for the patient , but maybe more risk for surgeon, because lateral is the surgeon don't have more experience can damage the nerve. Ai ask one month ago, I ask a surgeon ,and he told me he perform the same like you. He said yes is some surgeon what do lateral , but if needed more experience and need be very professional for do this. I ask for Lumbar segment not Cervical. You can search on youtube and see what I'm about. I also found local surgeon who perform in this way.
Now explain to people what happends when the bone tries to grow back in many different directions, when the cut longitude ligament destablizes the vertebrae and then calcifies, when the facet join is unstable and causes horrible chronic arthritic pain. These my friends are the consequences 5 years out on a 51 year old that can't function anymore because the bonati spine institute in hudson FL did this when she had a broad central herniation, no discetomy was performed and now no other neurologist will touch her. Her life is over.
I'm afraid I can't comment on the specifics of your situation. This is not a stabilizing procedure and can contribute to ongoing degeneration and instability. I don't really know what options she has unfortunately. Good luck, -SP
Having this done 2/15/24 C7 for right arm issues/neck..... Question is, how long does it take to heal/ and how long typically do you have to be on narcotics from your standpoint?
@@XX-166 ok so the procedure went very well, was supposed to be in overnight but I opted to come home ...not going to sugar coat the fact that I was ON THE PAIN MEDS like clockwork for the first couple days.... Then switched to Aleve so I could return to work.... Was super tight for a bit.... Still having some burning back there and pain when bending over like unloading dishwasher for example. But other than that my arm/shoulder is feeling great! I'm sure I still have a few weeks of healing internally to go through so I'm still careful and still taking 1 Aleve at most a day... Sometimes none... Hopefully after 6 weeks I'll be in good shape.
@@minivanventuring I thought this was a go home same day surgery and back to regular activities within 2-3 days. How was your range of motion before and after and was there a neck brace needed?
@@XX-166 I thought so to! I guess it depends on the person, NO on the neck brace, but sleeping on back is preferred(although I'm a side sleeper)while healing. Same day I suppose if all goes well, I think overnight in the PACU if you need extra pain management via IV... I just wasn't down for it lol. They said would you like to go home I said oh yeah.... But needed LOTS LOTS of pain meds before I left there. I basically had them load me to the max to be honest.
Extremely insightful. I have had 3 consults now and this procedure was just brought up today. I didn’t know how to ask questions on it but now this context has really cleared up things.
Excellent! I'm glad you found it useful! Good luck, -SP
The quality of this video is excellent. The way you can stand next to the images and point your opaque hand directly to the specific anatomy is very impressive.
Thank you and thanks for watching! -SP
im ortho resident , your videos are very useful and make easy to understand main concepts . thank you sir
My pleasure! Good luck in your residency. I'm glad you find this content valuable. Cheers, SP
What an amazing video Sir 👍👍 Thank you so much from a resident 🙏
Thanks so much! Glad it helped. Stay tuned for more videos -- I am trying to make a comprehensive library specifically aimed at helping spine surgeons in training and early practice. And tell all your coresidents and friends! ;-)
Really informative video with crystal clear concepts....!
Thank you for Educating and helping Humanity....!!!
My pleasure! I'm glad you found it useful! Good luck, -SP
This is very very helpful, thank you so much!
Awesome! I'm glad you found it helpful. Good luck! -SP
Great video. Why would you not do this procedure bilaterally during one procedure, and why would this procedure not reduce neck pain?
You can do it bilaterally. It amounts to twice the dissection, twice the muscle trauma and twice the time so it usually becomes slower than anterior appproaches that are midline and afford access to both sides. It's not that it can't be done -- it just becomes a less competitive option compared to the anterior approaches. Also, the pain generators for neck pain are usually not nerve-root related and this procedure is specifically targeted at decompressing the nerve. The surgery itself involves more muscle dissection and "trauma" so it can sometimes contribute to neck pain. Hope that helps, -SP
Thank you for the valuable information and response. You are making a difference@@prasadspineacademy
Very informative as I get ready to have this procedure next month.
Best of luck! -SP
How did it go? My doc just suggested it
Thank you for such an informative video. In the infrequent case of re-herniation following this procedure, is ADR still an option to restore loss of disc space and preserve motion. & if so, what artificial disc do you typically use in practice?
Great question. In the absence of instability on flexion extension xrays, and provided there are no other contraindications to ADR i think it would be a very reasonable option. I usually use Mobi-C but I don't think there's a strong advantage; depends more on your surgeons experience and comfort I would say. thanks! -SP
Excellent presentation. I have already cervical server central canal narrowing from c2-c5 due to ossification.Doctor said , surgery is the only option. But I have not server gaits or numbness in hand or leg. Mild pain only on neck. Is it necessary for a surgery doctor??. I am so worried about this matter because I have already so many other issues like subclavian artery blockages 70, diabetic and acid reflux and sleep apnea etc. could you please give me an opinion in this issue??. Australia
Thanks for watching. It is difficult to give you specific guidance as I am unable to examine you, review your imaging, etc. The decision-making should take many things into consideration that I don't have access to. I'm afraid I have to defer to the surgeon who saw you but it is always reasonable to get multiple opinions to reach a decision that you are comfortable with. Good luck! -SP
Great detailed animation .
Thanks so much! Cheers, -SP
Great presentation! I have this exact issue and my doc in Stuart Florida wants to do an Acdf probably because it’s easier and he’s trained for it. He’s actually kinda young and should know more procedures so I guess I’ll have to find another doctor. Thanks again as an informed patient is the best patient.
Glad you found it useful. ACDF may be a good option but it never hurts to get another opinion. Good luck! -SP
@@prasadspineacademyany chance you could attach a few pics of an mri that warrants this procedure?
Can you please make a video on Endoscopic Diskectomy vs MLD … I personally don’t see any difference between these two techniques, obviously it depends on personal choice and expertise. Need to listen from an expert like you. By the way very nice presentation on spine problems, I follow your channel carefully. Thanks from India.
Hi, you're talking about lumbar microdiskectomy vs endoscopic right?
@@prasadspineacademy yes ... Lumber microdiskectomy vs endoscopy
The link in the discription is private sir , how can we open it . Thanks
It seems to be working now. Sorry for the inconvenience. -SP
thank you.
Thanks you again. Cheers, -SP
Can this be used to treat a failed C5-C6 ACDF? The area has gone crazy with calcifications building up & is now flattening the spinal cord again. The calcification build-up is similar to your first herniated disc image, just bone not disc.
It will not address a non-union but it may help relieve symptoms from nerve compression. Hope that helps, -SP
@@prasadspineacademy Thank you. Recent MRI showed some other issues: ligamentum flavum buckling at every cervical level, Heterogeneous fatty marrow changes, thecal sac stenosis, (at C5-C6) severe left foraminal stenosis, and advanced right foraminal stenosis.
I have a a slightly herniated C5. Arm pain and numbness and shoulder pain. That’s my main issue.
I feel like I’m a good candidate for surgery.
It’s only on 1 side my left and I have full range of motion
Tried everything for 10yrs and can’t unpinch that nerve.
If I lift weights even light weight it tightens up.
I’m looking into this procedure. Thanks
If it's unilateral and your symptoms are from C4-5 foraminal stenosis and C5 radiculopathy then this may be a good option. Depending on your specific imaging and preferences foraminotomy, ACDF or anterior cervical disk replacement may all be reasonable considerations. Good luck! -SP
@@prasadspineacademyI’m debating between doing anterior Vs posterior on my C5/C6.
I had an offer to do laser anterior by Dr Duek and an offer to do posterior from another Dr. Mork.
Dr Mork is very reputable and he said it should work ok from back.
If you do anterior do you still need a laminatomy? I just worry about instability or reherniation from laminotomy
I’d rather go from back as raw as not dealing with cutting it leave scarring from neck in front
Hello sir. Nice presentation.What about just a Narrowing Foramen from Hypertrophy of articular process and small disc bulge, can do something just for foramen , like Foraminotomy but Lateral approach ? Just I ask because I saw here on youtube the intervention, but with lateral approach. Is it more complex, because of the complexity anatomy on the lateral ,or why you present just the Posterior approach? Is the posterior approach more ease to see and clean the foramen stenosis, with out damage the nerve, compare with lateral approach? But this posterior approach with laminoforaminotomy eliminate the lamina bon or part of it, this don't destabilize the vertebra, In the future, there can be no problems with the vertebra? What is the risk lateral compare with posterior Foraminotomy? Thank you.
Thanks for your question. I am not sure what you mean by "lateral approach". I do not know anyone that uses a purely lateral approach for the cervical spine. There are anterior foraminotomies that spare the bulk of the disk and there are variants on the posterior approach described here (endoscopic, tubular, etc). These involve removal of part of the lamina and medial joint to relieve pressure on the nerve. It is not considered to be significantly destabilizing. Good luck! -SP
@@prasadspineacademy Lateral I know sure , some surgeons do it from lateral side, not from posterior, what cause more damage to the patient. Why you need to cut to many things? Lateral insert the guidance close to the foramen and do all what is needed, with out cut lamina or something else.Is more easy for the patient , but maybe more risk for surgeon, because lateral is the surgeon don't have more experience can damage the nerve. Ai ask one month ago, I ask a surgeon ,and he told me he perform the same like you. He said yes is some surgeon what do lateral , but if needed more experience and need be very professional for do this. I ask for Lumbar segment not Cervical. You can search on youtube and see what I'm about. I also found local surgeon who perform in this way.
Now explain to people what happends when the bone tries to grow back in many different directions, when the cut longitude ligament destablizes the vertebrae and then calcifies, when the facet join is unstable and causes horrible chronic arthritic pain. These my friends are the consequences 5 years out on a 51 year old that can't function anymore because the bonati spine institute in hudson FL did this when she had a broad central herniation, no discetomy was performed and now no other neurologist will touch her. Her life is over.
I was actually thinking of this being a possibility sorry to hear but I guess my thought wasn't out of reach
I'm afraid I can't comment on the specifics of your situation. This is not a stabilizing procedure and can contribute to ongoing degeneration and instability. I don't really know what options she has unfortunately. Good luck, -SP
Having this done 2/15/24 C7 for right arm issues/neck.....
Question is, how long does it take to heal/ and how long typically do you have to be on narcotics from your standpoint?
It varies depending on technique. It's a good idea to ask your surgeon. good luck, -SP
Give us an update on how you’re doing, how long was the procedure and your ability to heal and get back to everyday activities
@@XX-166 ok so the procedure went very well, was supposed to be in overnight but I opted to come home ...not going to sugar coat the fact that I was ON THE PAIN MEDS like clockwork for the first couple days.... Then switched to Aleve so I could return to work.... Was super tight for a bit.... Still having some burning back there and pain when bending over like unloading dishwasher for example. But other than that my arm/shoulder is feeling great! I'm sure I still have a few weeks of healing internally to go through so I'm still careful and still taking 1 Aleve at most a day... Sometimes none... Hopefully after 6 weeks I'll be in good shape.
@@minivanventuring I thought this was a go home same day surgery and back to regular activities within 2-3 days. How was your range of motion before and after and was there a neck brace needed?
@@XX-166 I thought so to! I guess it depends on the person, NO on the neck brace, but sleeping on back is preferred(although I'm a side sleeper)while healing.
Same day I suppose if all goes well, I think overnight in the PACU if you need extra pain management via IV... I just wasn't down for it lol. They said would you like to go home I said oh yeah.... But needed LOTS LOTS of pain meds before I left there. I basically had them load me to the max to be honest.