A Better Approach to Spinal Bone Spur Surgery Renowned Spine Surgeon Dr. Kaixuan Liu Explains Endoscopic Foraminotomy

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If spinal bone spurs develop in the wrong place, they can press against nerves and cause serious symptoms. For some people, advancements in endoscopic foraminotomy have given them hope to live a more active life.

Kaixuan Liu MD, PhD

Kaixuan Liu MD, PhD

Bone spurs on their own are completely benign, in most cases just another part of getting older

To most people, the term “bone spur” brings to mind a cowboy and his boots. But for someone with spinal bone spurs, the term can have a decidedly different association. If they develop in the wrong place, spinal bone spurs can press against nerves and cause serious symptoms: intense pain, decreased range of motion, tingling or numbness, even difficulty swallowing or breathing. In those cases, an operation may be the only option. But luckily, according to Kaixuan Liu, MD, PhD, chief surgeon at Atlantic Spine Center, today there are choices in bone spur surgery, including a new and advanced procedure known as endoscopic foraminotomy.

Bone spurs, known formally as osteophytes, are small, smooth knobs that can form on the bones as a result of injury—the traumatic kind as well as the day in, day out, wear-and-tear kind that comes with aging, says Dr. Liu. In many cases, osteophytes are one of the damaging effects of osteoarthritis, which triggers the formation of more bone in and around the structures that are being eroded.

Most people are surprised to learn that bone spurs are extremely common—almost everyone will develop them at some point in their lives—and often produce no symptoms. “Bone spurs on their own are completely benign, in most cases just another part of getting older,” Dr. Liu explains. “A patient can have them for many years without even knowing it.” But he estimates that about 40 percent of people with spinal bone spurs will eventually experience nerve compression and its attendant symptoms.

Problems arise if bone spurs develop around one or more foramen, which are openings in the bony spine that surround the spinal nerves as they branch away from the spinal cord. In those cases, the spurs narrow the foramen, which then impinges the nerves and produces pain and other symptoms. Spinal bone spurs develop most often in the cervical (neck) and lumbar (lower back) regions of the spine.

Bone Spurs Surgery: Explaining Endoscopic Foraminotomy
The good news is that, in the vast majority of cases—about 90 percent, Dr. Liu says—osteophyte-related symptoms can be managed with conservative treatments such as pain relievers, targeted exercises, and physical therapy. But in cases where these measures aren’t helping, patients can opt for surgery, in which a doctor removes the troublesome osteophytes and widens the foramen to relieve the pressure on the affected nerve or nerves.

Until recently, the only surgical option was what’s known as “open” spinal surgery, in which the doctor made a fairly large incision, cutting through skin and muscle in order to reach the spinal structures and remove the bone spurs. The procedure involved general anesthesia, a hospital stay, and a long (and painful) recovery.

Dr. Liu is one of a handful of surgeons who perform a much less invasive procedure known as an endoscopic foraminotomy. Foraminotomy is the term for the surgical removal of part of the spinal foramen, Dr. Liu explains. “It’s ‘endoscopic’ because we use an instrument called an endoscope, which is a tiny camera that lets us access the affected foramen and remove the bone spurs by making an incision that’s less than an inch long.” The advantages of this procedure are many, he says: local vs. general anesthesia, the elimination of a hospital stay, less risk of infection, and much less damage to the surrounding tissue (which means a much shorter and less painful recovery).

In an endoscopic foraminotomy, the surgeon inserts a small tube about the size of a pencil into the affected area of the spine and uses a laser or other tool to clear away the bone spurs and any damaged parts of the foramen in order to enlarge the opening and relieve the pressure on the nerve, Dr. Liu explains. “When the operation is complete, the doctor closes the incision with a stich or two, and the patient can go home the same day,” he adds.

About Dr. Liu: Kaixuan Liu, M.D., Ph.D., is a renowned endoscopic spine surgeon and founder of Atlantic Spine Center in West Orange, New Jersey (http://www.atlanticspinecenter.com).Dr. Liu is certified by The American Board of Pain Medicine and The American Board of Anesthesiology, and is a member of The International Society for Advancement of Spine Surgery, The American Society of Interventional Pain Physicians (ASIPP), The American Academy of Pain Medicine (AAPM), The International Intradiscal Therapy Society (IITS), and The American Society of Anesthesiologists (ASA). He also serves as an international surgeon for The Spinal Foundations in England.

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