Think my 2 best options are.... Any Advice?

[cp7959]

SED sounds interesting, especially since I have an Annular tear. I have a few questions if anyone has the experience to answer.

With the SED procedure, does the Dr. enter the disk from the back going thru soft tissue only or does he create a path thru bone?

With the endoscope entering the disk thru an access point other than the tear, does this create another week spot in the disk in which another tear can form?

How long does the SED last, is it a short term fix, what are the long term results?

And the $$$$ question, how much? I'm sure my BCBS insurance isn't on board with this.

Thanks in advance.

[mmglobal]

I think that most insurance providers will not fund SED. Having said that, I still think it's odd that a spine center will go out of it's way to tell a patient that another center's procedure is not covered. I would check with the SED provider. As I said it may not be covered, but I would not depend on the info received from a competitor.

Anyone considering SED should contact the SED doctors for inclusion criteria. From my memory (which cannot be trusted), discs with grade V tears are not good candidates. Discs with severe collapse and loss of disc height are not good candidates. Classic discectomy candidates are good candidates for SED. This leads me to the conclusion that if you are a good candidate for one, you stand a good chance for all of the procedures, whatever the 'twist' they add in addition to the traditional discectomy. Having said that, I believe that the thermal annuloplasty as the twist, gives SED a chance to deal with discogenic LBP that most other discectomy techniques don't. If I could go back and redo my 2000 and 2001 discectomies, I would do SED.

How long will it last... depends on how lucky you are. IMHO, if you get a few years out of it, you win. More and you win big. Like all discectomies, there is a substantial chance that success will last only a few months. The recurrant herniation story is very common. Even so, the alternatives (adr and fusion) are to be avoided if possible... so IMHO, good candidates for discecomy should try it first instead of opting for the bigger surgery first. If you fail that (like my wife did... her endoscopic discectomy was a great success, but only for 3 months) you are unlucky and lose the bet.

Mark

[mmglobal]

Access for SED is like most endo discectomies... it is through the soft tissue and follows the path of the discogram needle. They use expanding canulas... increasing diameter tubes to convert the needle stick into an opening large enough to accomodate the scope.

Even though they use the needle path for the scope, the may still have to remove a small amount of bone to clear the scope. THIS IS WHERE ALL MISS PROCEDURES ARE NOT CREATED EQUAL. I have several clients who thought they were getting MISS procedures that would preserve their later ADR option, but the surgeon removed too much bone, basically removing a facet, and destabilized the system so that ADR was no longer an option.

You must discuss this with the surgeon in advance and be certain that he understands and is experienced enought not to just do it the easy way... but to get it done the right way. In one of these cases, it was a complete surprise when the patient discovered 6 months later that a facet had been removed. So much for MISS for him.

Mark