Endoscopic Transforaminal Decompression Interbody Fusion (ETDIF) Surgery in Nagaon

Spine surgery has been around for quite some time and is used to treat spinal disorders. It has helped several patients get relief from pain, better mobility, and improved neurological symptoms. However, it is also true that traditional open spine surgery is a major surgery that can cause significant postoperative pain and involves a lengthy recovery process. If you are looking for a less invasive alternative to traditional spine surgery, endoscopic transforaminal decompression interbody fusion (ETDIF) surgery can be considered. Let’s find out more about this spine surgery technique in this article. 

Endoscopic transforaminal decompression interbody fusion (ETDIF) surgery is a minimally invasive spinal fusion technique used to treat various spinal conditions that cause nerve compression and instability in the spine. 

Let’s see what the various terms in the name of the procedure mean. Endoscopic transforaminal decompression interbody fusion (ETDIF) surgery involves two distinct surgical procedures: ‘transforaminal decompression’ and ‘interbody fusion’, both of which are performed using an endoscope.

The surgery makes use of an endoscope, which is a thin and flexible tube with a light and a camera at the end to enable visualization of the surgical site without the requirement for a large incision. Small specialized instruments can also be inserted through the endoscope to conduct the surgery.

The term "transforaminal decompression" refers to the insertion of the endoscope into the operative spine area through a natural opening in the spine called the neural foramen or foraminal opening (transforaminal) and the removal of a portion of damaged bone or disc that is pressing on a spinal nerve (decompressing) through this opening. 

The term "interbody fusion" refers to the placement of an interbody fusion cage through the endoscope. The interbody fusion cage contains bone graft material and is inserted between the adjacent vertebrae to stimulate bone growth, fuse vertebrae together, and stabilize the spine. 

By combining these two surgical procedures, ETDIF surgery can achieve decompression and fusion in a single procedure. During endoscopic transforaminal decompression interbody fusion (ETDIF) surgery, the surgeon uses the endoscope to access the spine through a small incision in the back and remove the damaged portion of the disc or bone, relieving pressure on the spinal nerves and restoring normal spinal alignment. 

Then, the surgeon uses the endoscope to place the interbody fusion cage in the correct position and hold it in place with fixation devices such as screws. ETDIF is a less invasive alternative to traditional open spine surgery, resulting in less pain, scarring, and recovery time.

Endoscopic transforaminal decompression interbody fusion (ETDIF) surgery may be recommended for the following spinal disorders:

• Herniated Discs: A condition in which the soft center of a spinal disc pushes through a crack in the outer casing and causes nerve compression and pain. ETDIF surgery can remove the herniated disc material and relieve pressure on the nerve.
• Spinal Stenosis: It is the narrowing of the spinal canal, which puts pressure on the spinal cord and the nerves within the spine. ETDIF surgery can be used to remove the material causing the narrowing of the canal and relieve pressure on the nerves.
• Degenerative Disc Disease: It is a condition in which the discs between the vertebrae degenerate or break down with aging, and cause pain and instability in the spine. ETDIF surgery can be employed to remove the damaged disc material and fuse vertebrae together to stabilize the spine.
• Spondylolisthesis: It is a spinal disorder in which a vertebra slips out of place, forward onto the bone below it. This can cause nerve compression and pain. ETDIF surgery can realign the vertebra, fuse them together, and stabilize the spine.

Before Surgery:

• You should consult a spine specialist about your health condition and discuss the ETDIF surgery procedure in detail. Use this consultation to talk about your expectations and doubts about the procedure, as well as its benefits and risks. 
• Before giving you the go-ahead for the surgery, the doctor will discuss your medical and surgical history, as well as any current medication you are on. 
• As part of pre-surgical testing, you may be asked to undergo various tests, including a physical examination, blood work, and diagnostic imaging to assess your health and suitability for the surgery. 
• You may be asked not to eat or drink anything for a few hours before the procedure.
• You will have to arrange for someone to drive you home once the surgery is done. 

During Surgery:

• The surgeon starts by making you lie face down for the procedure and administering general anesthesia.
• Then, the surgeon makes an incision of about 1 cm on the side of the spine which is most symptomatic. The incision is made at the level of the problematic disc.
• The disc to be operated upon is identified using fluoroscopic (live X-ray) visualization.
• The surgeon then inserts a thin tube via the incision into the disc area through the neural foramen opening. They may use a dilator to enlarge the size of the tube and provide a working channel for the operative instruments.
• The endoscope is inserted through the tube into the disc and the disc area is irrigated with an antibiotic solution to minimize the risk of infection.
• Special instruments are inserted into the tube to remove the damaged portion of the disc.
• Parts of the disc that are cut away are extracted through the tube. The cartilage covering the bone surfaces bordering the disc is also removed and extracted through the tube.
• The disc height and normal spacing between the vertebrae are restored as needed by inserting dilators into the disc.
• The success of the disc preparation process is confirmed endoscopically. 
• The disc space is then packed with bone graft. The bone graft material may include bone chips from the patient’s hip bone, cadaver bone mixed with bone marrow from the patient, and cadaver bone inserted with a bullet-shaped cage (implant).
• Screws reinforced with rods may be attached to the back of the vertebra to add stability to the area and prevent any movement while the bone graft sets. The bone graft fosters bone growth around these rods, which may be left in place even after the bone graft has taken hold.
• The wound is closed using absorbable sutures and a local anesthetic is administered into the surgical area to help with postoperative pain control. 
• An antibiotic dressing is applied to the wound.
• The entire procedure may take between 1.5-2.0 hours, and in some cases, even longer to complete.

After Surgery:

• You will be monitored for several hours in the recovery area after the surgery.
• You may be required to stay in the hospital for 1 to 2 nights after the surgery.
• You may be discharged and allowed to return home once you are able to stand up and walk around without any problems.
• The surgeon will prescribe oral pain medications to manage pain for about 1 to 2 weeks post-surgery.
• The surgeon will also give you post-operative instructions including activity recommendations and a follow-up appointment schedule. Make sure you follow all the instructions for an efficient recovery. 
• It is advisable to rest as much as possible in the first week, with gentle stretching and short walks, if tolerated well. 
• If you have an office job, you should be able to return to work in 1 to 4 weeks after the surgery. Those with manual jobs may need to wait for several months before being considered fit to return to work.

Benefits: 

The advantages or benefits associated with endoscopic transforaminal decompression interbody fusion (ETDIF) surgery include: 

• Minimally invasive
• Shorter time under the influence of anesthesia
• Reduced surgical trauma
• Minimal blood loss
• Faster recovery 
• Less postoperative pain

Risks:

Any surgery will have some risks associated with it. The risks or potential complications associated with endoscopic transforaminal decompression interbody fusion (ETDIF) surgery include:

• Infection
• Bleeding
• Pain at the site of the bone graft
• Nerve damage 
• Blood clots
• Non-resolution of pre-surgery symptoms

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!