Removal of Lumbar Foraminal Free Fragments with a New “Nano” Endoscope, Long Term Follow-up

EANS 2024 Annual Congress. Sofia, Bulgaria on October 13-17, 2024

Introduction

The nano endoscopic partial discectomy is a high-tech procedure, done only at the Back
Institute Surgery Center (BISC), since the proprietary technology and techniques for doing
these small size operations were developed at the BISC.

The foraminal procedures in this study involved the passing of an endoscope, grasper, and
a straight cannula of approximately 4 mm diameter into the proper location without any
cutting or drilling inside the body. Years ago, we determined the smallest functional
grasper size; smaller graspers do not work to remove disc. The disc pathology noted below
was removed without any bleeding, retraction, or dissection which commonly leads to
Scarring in invasive discectomy procedures. These non-cutting procedures are not invasive
in comparison to “minimally invasive” operations that cut tissue.

Methods

A retrospective review was done of 153 patient records who had lumbar nano
endoscopic partial discectomies between 2020 and 2024.

Six patients were found that had lumbar foraminal free fragments and were available for
long term follow-up.

All six patients had low back pain, radicular pain, numbness and weakness due to
dorsal root ganglion(DRG)/exiting nerve root compromise by free disc fragments
ruptured into a confined space.

Length of follow up ranged from one year to four years with an average follow up period
of 24.3 months.

Results

There were no intra-operative or post operative complications.

All six patients had an excellent result by MacNab criteria at last follow-up.

ODI improved from an average pre-op of 73.2% disability to 7.0 % post op.

Conclusion

Unique equipment, which included a cannula, endoscope and grasper system significantly
smaller than the DRG/exiting nerve root, allowed foraminal nano endoscopic partial
discectomy procedures to be safe and effective in this group of 6 patients.