By Benjamin Engel
Surgical interventions behind closed doors are no more. Michael Schubert demonstrates an endoscopic disk surgery (TESSYS technique) that is transmitted live on a big screen.
Very many people in Germany suffer from back pain. Mostly the symptoms resolve spontaneously over time. In some cases, however, they may radiate into the leg and cause severe pain. Then it will probably be a slipped disk. Tissue material from the disk center protrudes into the spinal canal, pinches one or more nerve roots and can hence be removed surgically. According to the Federal Statistical Office, in 2008 about 230.000 people alone had lumbar spine surgery.
Michael Schubert demonstrates an endoscopic disk surgery in Starnberg (TESSYS technique) that is transmitted live on a big screen. (© Franz-Xaver Fuchs)
For the fifth time already Joimax (TESSYS) carried out an international workshop on endoscopic disk surgery of the lumbar spine region. In close cooperation with physicians, the company developed this technique that has now been applied and constantly refined since seven years. Orthopedic specialists and surgeons from all over the word, from Europe to the Middle East could follow two endoscopic disk surgeries live on a big screen in the conference hall of Klinikum Starnberg. Spine surgeon Michael Schubert from the Munich APEX SPINE Center, co-organizer of the workshop demonstrated the technique and was available for questions.
Most widespread is still microsurgical technique with the aid of a microscope. For this type of surgery a four to five centimeter long cut is required to get access to the affected vertebrae. Despite this fact, only five percent of all slipped disks are operated on endoscopically even though this procedure is exceptionally tissue-preserving. The instruments are inserted through a small incision that is only 7,5 mm wide. Additionally local anesthesia will do, so that the patient remains responsive during the entire intervention.
However, followers of the conventional procedure disapprove of this form of treatment as they take it for too risky. The Würzburg orthopedic specialist Florian Maria Alfen – besides Michael Schubert one of the pioneers of this method – cannot understand this criticism. According to him, nobody should have to undergo open spine surgery anymore as in his opinion the new method provides nothing but advantages for the patients. Muscles and soft tissue would be preserved and there would be no traumata. To some extent patients are able to do their first steps already after three hours and can be discharged the following day, as was confirmed also by Wolfgang Kreil from the neurosurgical department of the University of Graz.
According to the present surgeons, the long learning curve of about 20-30 guided interventions and the need of constant training are responsible for the slow acceptance of the endoscopic surgery method. Florian Maria Alfen assumes that there are only 10 specialists worldwide that can master this procedure also in difficult cases.
The fact, that more money can be made with conventional surgery technique – for example by the insertion of screws or implants - also plays a role, says Wolfgang Ries, the founder of Joimax. However, just like the involved physicians, he is convinced that the endoscopic method is worldwide on a trail of success. The technique is now being applied already for about 30% of all interventions in South Korea.