A decade of endoscopic spine surgery in Panama

Dr. Andrés Báez, one of the pioneers of minimally invasive spine surgery in the isthmus, recounts his experience with this procedure, its benefits for patients and how it has evolved.

Ten years ago, Dr. Andrés Báez, a specialist in minimally invasive spine surgery, began offering endoscopic spine surgery to his patients. In the last decade, it has been proposed to educate patients, their colleagues and insurance companies about this technique that reduces days of hospitalization and allows the patient to return to their daily activities sooner.

When Dr. Báez returned to Panama, trained in this technique, he made an effort to make it known to his patients and colleagues. At that time most only knew about microdisectomy, a conventional open surgery that requires making an incision in the back; The surgeon views the discs through a special microscope. It is a well-known technique that continues to be used. His proposal, endoscopic spinal surgery, does not require cutting muscles, bone or ligaments of the spine. In this way, it achieves the same objectives as a traditional open surgery, but with a much faster recovery. 

minimally invasive

Endoscopic surgery is done through a camera or lens, which is introduced using an eight-millimeter tube. Using this camera, the nervous structures can be visualized and protected, while the fragment of the disc that compresses the nerves and therefore causes pain is located and removed. No need to cut muscles or bones. "We visualize the nervous structures, protect them and reach the hernia to remove it," explains the doctor.

The tissue injury is so small that sometimes in postoperative MRIs there does not seem to be evidence of a previous surgery, since there is no evidence of scars or damage to muscles or bones, but there is evidence of the extraction of the herniated disc and an adequate release. of the nerve roots.

Dr. Báez began using this technique in patients with pain due to herniated disc. The majority of those who suffer from this condition usually continue with activities without realizing that they suffer from it. Some describe the symptoms like this: "back pain", "pain that goes to the leg", but it usually disappears after taking some medication or resting. Years can pass like this. Only 10% of people who suffer from it usually have pain that is so frequent or intense that they seek a medical evaluation and obtain a diagnosis. 

Even among these patients, 90% improve with medications, therapy and other conventional treatments, which is the first thing indicated. Only a minority of people continue to have pain that limits their activities such as working, playing sports, and their quality of life is affected. These are the patients for whom surgery is recommended. And among the surgical management options for a herniated disc, endoscopic spine surgery is the least invasive technique that exists.

In some cases it can be scheduled on an outpatient basis, the person undergoes surgery and returns home that same day. The duration of surgery depends on the severity, size of the hernia and its location. Surgeries, which previously took up to 3 hours with open techniques, are now sometimes performed in less than 30 minutes due to the benefits of minimal invasion.

The advantages are not only in the surgery time, but in the period of time in which the patient can leave the hospital, return to their daily activities such as working, exercising, recreating, traveling. Postoperative care and monitoring is equally important, especially during the healing process. Dr. Báez tells us that "many times we have to remind the patient that even if they have a wound of only 8mm in their back and the pain has improved a lot or no longer exists, they have just had spinal surgery and they should take care of themselves."

Endoscopic spine surgery is a technique that is increasingly being applied in more countries and in more indications. Initially it was used only for herniated discs. Nowadays there are endoscopic techniques for the management of foraminal or facet cysts, for stenosis or narrow lumbar canal. Fusion surgeries can even be performed, where the disc space is prepared through Endoscopic surgery, and then boxes, screws and fusion bars are placed in the operated segment through other incisions.

Previously, to attend an endoscopic surgery seminar you had to belong to specific societies and they were only taught in certain places. Currently, the large spine surgery societies in North America and Europe include endoscopic spine surgery in their modules.

Training requires dedication and time, the learning curve required is not short. The specialist learns to see the spine through a monitor while working with his hands. In traditional surgery, surgeons are used to seeing the spine through a microscope in an open wound.

He received his training from Colombian doctor Jorge Felipe Ramírez, the first to implement the technique in Latin America in the mid-1990s. Today Dr. Baez is considered an Instructor in Endoscopic Spine Surgery, and along with those who were his teachers, continues to give importance to the training of his colleagues in these techniques, for the benefit of patients.

In May, Dr. Báez will meet with his professors and other pioneers in Endoscopic Spine surgery worldwide, to celebrate 30 years of the beginning of this technique in Latin America. Dr. Baez will present his experience in 10 years of performing this technique in the Republic of Panama.