Francis A. Pflum, M.D., Spine Arthroscopy Center Of New York And New Jersey

Our Services

The intervertebral disc is a shock absorber between two vertebral bodies but it is also a joint made out of cartilage and therefore an endoscopy of this joint
would more appropriately be included in “ARTHROSCOPY” therefore excision of this disc from inside out is referred to as
“SPINAL ARTHROSCOPY”.

In the process of performing SPINAL ARTHROSCOPY in the neck there are many vital structures in a small area therefore a second person is mandatory for maximum
patient safety. The availability of an excellent, specifically, trained assistant is unusual, therefore Dr. Pflum performs this procedure with a co-surgeon. This co-surgeon
not only performs the procedure with Dr. Pflum but independently evaluates and counsels the patient pre-operatively, agrees or disagrees to do the procedure with Dr. Pflum and equally shares in the responsibility for the patient.

Below are just three of the many procedures Dr. Pflum regularly performs to alleviate pain.

Anterior Arthroscopic Cervical Discectomy
Open anterior cervical discectomy with or without fusion is the
standard operative treatment for cervical disc disease at this time.
If the treating physician is to fully counsel his patient concerning
surgical alternatives, then cervical endoscopic discectomy must be
included.

Open anterior cervical procedures are very intimidating, cervical endoscopy is much less intimidating. This arthroscopy and discectomy have been made possible with advanced technology and are performed through a very small incision. This procedure is performed under general anesthesia with spinal monitoring for maximum patient safety. The skin over the involved disc is identified with the use of fluoroscopy. The soft tissues are pushed out of the way by an assistant or a co-surgeon. A needle is passed through the skin and soft tissue for a short distance into the disc, and an arthroscope is passed over the needle into the disc and the needle is removed.

The inside of the disc is then visualized and the portion of the disc responsible for the symptoms is removed with motorized instruments and also under direct visualization. A Band-Aid size dressing is applied and cervical collar is used for approximately two weeks.

Many patient have significant relief of their symptoms immediately following surgery. The patient is routinely discharged the same day and can resume normal physical activities in two to six weeks.
Benefits of cervical selective endoscopic disc when compared to alternative surgical procedures:

• Minimal scarring
• Minimal discomfort ? much less pain than with open procedures
• Reasonably less chance of complications than with open surgery
• Anterior structure of the disc is still maintained
• No planned hospitalization
• Faster return to normal activity
• Probable significant cost savings

Lumbar Endoscopic Discectomy
This procedure is a true break through for surgery for the lumbar spine. Other minimally invasive spinal procedures fall into two categories, (1) open surgery with a smaller incision or (2) a procedure or method to shrink or change the disc through the use of an instrument passes through a needle. Endoscopic discectomy is a variation of the arthroscopic surgery of the joints and should more
appropriately be called Spine Arthroscopy. With the patient under sedation with only local anesthesia, this procedure employs the use of x-ray guidance to insert a scope into the disc usually from both sides. Under direct visualization the disc material may be removed using
state-of-the-art technology.
Precision made instruments are passed through the scope; these include radiofrequency probes, lasers, and the same instruments used in open surgery. The targeted portions of the discs are excised, under some instances the broken outer portion of the disc may be sealed and the rest of the disc left behind. Walking is permitted the same day and the patient is discharged within a few hours.

Benefits of selective lumbar endoscopic discectomy when compared to alternative open surgical procedures:

• Much less pain, post-operatively
• A very small incision
• The structure of the disc is largely left intact
• The pinched nerves may be directly visualized
• Complications are reasonably less than open surgery as much less soft tissue injury occurs
• Probably significant cost savingss

Lumbar Endoscopic Fusion
At times, spine disease progresses past the point where a simple removal of displaced disc material or painful disc material can alleviate pain. This often leads to the suggestion by the treating doctor to fuse several segments of the spine. Recent advances in an area known as granular mechanics have made it possible to replace a removed disc with bone chips in a small porous bag. This may be
performed with an open procedure or a scope.

Why would a patient choose an open procedure if this can be done through a scope? Coupled with minimally invasive open instrumentation posteriorly this greatly decreases time and damage
of fusion procedures.