Dr. George Rappard Presents Long-term Safety and Effectiveness Data on Endoscopic Lumbar Spine Surgery at the 25th Annual Meeting of the Spine Intervention Society

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Endoscopic discectomy for herniated disc causing back and leg pain is a safe and effective procedure, based on long-term follow up in a large cohort of patients. Patients in the study exhibited marked reductions in pain and disability after surgery that continued at long-term.

"...We can confidently say that endoscopic surgery is as safe and effective as traditional spine surgery, but with a much more rapid recovery."

Los Angeles Minimally Invasive Spine Institute director, Dr. George Rappard, reported on the results of a long-term study group of 108 patients who underwent endoscopic lumbar discectomy for the treatment of a herniated disc. All patients were discharged home on the day of surgery. The average follow-up in the study group was 11 months after undergoing endoscopic surgery. Rappard, a neurointerventional surgeon, defined success as having achieved a scientifically and medically meaningful level of pain relief or diminished disability. Long-term success was achieved in 90% of cases. In successfully treated cases back pain was reduced by 61%, sciatica, or leg pain, was reduced by 60% and disability was reduced by 50%. Rappard notes that these results are consistent with the long-term results of more invasive spine surgery.

This long-term follow up also provided data on safety and robustness. Worsening neurological symptoms or nerve injury was seen in 2 cases (1.9%) There was a single case of infection noted after surgery. 2 patients suffered a re-herniation after their initial endoscopic operation (1.9%). Overall, endoscopic discectomy in this study was as safe as larger surgical procedures with a reduced risk of a 2nd herniation after surgery.

A spinal disc is a cushiony and rubbery structure located between the bones of the spine. A herniated disc is a condition that occurs when a tear in the outer lining of the disc allows the soft center of the disc to protrude through the lining, causing pain and compressing the nerves of the spine. The condition is very common, occurring 3 million times a year in the United States. Some disc herniations get better on their own while some do not. Herniated discs are a common cause of back pain, now the leading cause of disability worldwide. A herniated disc can also cause sciatica. Sciatica is a severe burning pain down the thigh and leg.

Endoscopic discectomy is an ultra-minimally invasive means of treating painful herniated discs that have not improved on their own or with therapy. Endoscopic surgery differs from commonly practiced forms of minimally invasive surgery in that surgery is performed through a tiny tube. The tube is small enough that in most cases it can be introduced into the spine without disrupting normal structures or cutting bone. The usual incision is about the size of a pinky nail. This is less than half the size of a typical “band-aid” incision. Surgery is performed with microscopic instruments, lasers and radiofrequency probes and is guided using an endoscope. An endoscope is a small tube with a high-resolution camera at one end and a lens at the other end. The endoscope allows the surgeon a bird’s eye view of the spine through a tiny incision. Because the procedure is ultra-minimally invasive, patients go home the day of surgery and recovery is rapid.

Rappard notes that this study adds to the growing body of scientific literature on endoscopic lumbar disc surgery. “This study is important for several reasons,” says Rappard. “The study involves a large number of patients and they have been followed over a long period of time. Based on the results we can confidently say that endoscopic surgery is as safe and effective as traditional spine surgery, but with a much more rapid recovery.” Rappard’s results are similar to other long-term trials on endoscopic spine surgery published in the scientific literature. The growing evidence of effectiveness has lead Medicare to recognize out-patient endoscopic surgery as a viable option for its beneficiaries and has lead leading spine medicine organizations to call for wider insurance coverage.

The Los Angeles Minimally Invasive Spine Institute was established by Dr. Rappard in 2012. The institute has its main office in the Miracle Mile region of Los Angeles. Dr. Rappard or Institute staff can be contacted at info(at)lamisinstitute(dot)com, through the institute at 323-857-5300, or on the web at http://www.laspinecare.com

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To learn more about minimally invasive and comprehensive spine therapies, visit the Los Angeles Minimally Invasive Spine Institute at http://www.laspinecare.com.

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Evelyn Gonzalez
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