Microdiscectomy vs Endoscopic Discectomy: Is there a difference

If you’ve been told you need back surgery for a herniated disc, you’re probably asking:

What’s the difference between an endoscopic discectomy and a microdiscectomy? And should I be scared?

In this episode, I sit down with two board-certified neurosurgeons from The Endoscopic Spine Institute of New York. Dr Sanjay Konakondla and Dr Albert Telfeian break down for us:

• Endoscopic discectomy vs microdiscectomy
• How each procedure is performed
• Recovery timelines and expectations
• Who is a candidate for each surgery
• Why surgery doesn’t have to be terrifying
• What “getting back to normal” really looks like

If you’re dealing with a lumbar disc herniation, sciatica, or considering back surgery, this conversation will give you clarity and calm.

We discuss how modern spine surgery has evolved, what actually happens in the operating room, and why many patients return to walking, working, exercising, and living fully again.

Whether you're researching minimally invasive spine surgery or trying to decide between endoscopic spine surgery and microdiscectomy, this episode will help you understand your options.

Find The Endoscopic Spine Institute at:
https://esiny.com/

Transcript

Landing The Neurosurgeons

SPEAKER_01 0:00

Hello and welcome to this episode of Bed Back and Beyond. I am thrilled to bring you this episode. In fact, I'm going to use my favorite Southern phrase, just butter my butt and call me a biscuit. I am so excited. I have tried several times to get a surgeon, either neuro or orthopedic, to come on to this podcast and talk to us about different surgeries for herniated disc, but I haven't had any luck. And I just kind of assumed it was because my channel is not of noteworthy size. So I kind of gave up. But then I came across these two TikTok accounts. One is at The Spine Boss, and the other is at NYC S P-I-N-E. So New York Spine. Dr. Sanjay and Dr. Albert are two board-certified neurosurgeons that specialize in endoscopic dissectomies. And I've been watching them and kind of stalking their TikTok pages for several weeks now. And they just seem different to me. They are, of course, passionate about the procedure that they perform, but they also just exude this passion for patient care and patient outcome. And they can you can tell with their vibe with each other, they they just work so well that they are partners that you can trust. And so I decided to shoot my shot and wrote a comment, hey, do you guys do podcasts? And then you know ran away. And they responded and they said, Hey, email us your information. And I did that, and they scheduled with me within days. Neurosurgeons are so busy, and yet these two doctors took time out of their schedule to come onto the Bed Back and Beyond podcast to explain endoscopic dissectomy and how it's different from a microdisectomy. And I just really appreciate being able to bring this information to you guys who are looking to make the right decisions regarding your herniated disc care. So let's go ahead and jump right into this episode.

Why Endoscopy Became Their Mission

SPEAKER_00 2:15

Welcome to Bed Back and Beyond, sharing positive stories of recovery from serious back or neck injury. Your host is CK, a fellow champion who draws on her own experience with herniated disc surgery. Join her as she talks with others who have overcome the physical and emotional trauma of a painful injury. And discover for yourself how you can find hope and encouragement in recovery.

SPEAKER_01 2:44

Dr. Sanjay and Dr. Albert, thank you so much. I don't think I can express how grateful I am that you are taking the time out of your schedule to talk to us on my little podcast, Bed Back and Beyond. Before we dive into endoscopic surgery, do you mind just introducing yourselves and explaining how you even came to focus on endoscopic procedures?

SPEAKER_03 3:06

I'll let Albert go first since he's uh he's got a he's got a good story here, and then I'll tag on how I started. But you know, I just wanted to say thanks. I mean, we feel a little starstruck being on this with you because Albert and I were just like looking at your YouTube and everything, and the amount of content you have there for all your patients, for all the patients that you help and the people like you is just uh it's super noteworthy. And um, I was telling Albert we're probably gonna, and I was telling Christine as soon as we got on here that we're probably just gonna link all our patients to your YouTube because it has so much good information there.

SPEAKER_01 3:39

Oh, thank you. That just means so much to me.

SPEAKER_03 3:41

No, it's awesome, it's awesome.

SPEAKER_02 3:44

Yeah, so so you know, my story, you know, I I was um I was 40 years old exactly. Oh, that's such a long time ago. Yeah, yeah. And I I had already done thousands of spine surgeries. I I had done a spine fellowship in Switzerland, and I was always obsessed with the spine, and then I had my first herniated disc.

SPEAKER_01 4:13

Oh, a fellow patient.

SPEAKER_02 4:15

I that it it so you know this this is the thing, you know, that you know, God gave me, you know, to make me first a better doctor, right? To understand what it was like. And, you know, it was two years of this pain, you know, started as back pain and leg pain. And I would go to work every morning crying, crying, thinking, I'm gonna need surgery. And I was so afraid because I'd seen, you know, so many people who had herniated disc surgery, you know, and they herniated again, and then they're looking at fusions, and my kids were one and two years old, and you know, I wanted to be an active dad. I had a long career ahead of me. And I was very lucky that when I went to medical school, I worked with this is in 1991, I worked with one of the first surgeons in the world doing laparoscopic gallbladders. And he was this young guy with a cheesy mustache, and you know, and other older surgeons would be like, oh, I I don't, you know, think I don't want to do that, you know, let somebody else do it. And he changed the field, right? He changed the how we do surgery. And I said, someday I want to be like that. So when it happened to me, you know, I I I said, I Googled, you know, endoscopics, you know, dysquectomy. Nothing came up. No publications, nothing. Right. And then, you know, I went and found one of the first people in the world who was playing around with it, spent a week with him. And then after that, I would fly anywhere in the world for anybody who was doing it, learned how to do it, and then 20 years later, you know, um, nobody's done more of these procedures uh um than my me and my partners. Nobody's published more papers, you know, it's just an obsession. And from from being a patient.

SPEAKER_01 6:08

Wow, that's amazing.

Training, Big Surgeries, And Tiny Cameras

unknown 6:09

Dr.

SPEAKER_01 6:10

Sanjay, how did you find yourself in that field?

SPEAKER_03 6:13

You know, Alber Albert and I both are neurosurgeons, and in neurosurgery residency training, all you want to do is the most advanced, huge, big, open wax, right? Where there's a bunch of instrumentation, you're you know, exposing all sorts of angles of the spine. And that's actually what I went to fellowship for. Okay. I went to do a spinal oncology fellowship. People who need big surgeries with big, big tumors in their spines, and in order to take them out, you need to expose the front and the back, the sides. And in a way, you know, obviously it helped a lot of people, but actually across the hall was Albert Telphian. And I was like, what's this guy doing over here with his tiny cameras and his, you know, and his uh and his big screen TVs? And it was just a completely it was on the completely other side of the spectrum, these types of surgeries. So, you know, on one hand, I had, you know, a fully maximally invasive type of experience. And then on the other hand, this minimally invasive endoscopic, ultra minimally invasive endoscopic exposure. And in a lot of ways, the wide open approach to spine surgery made me a better endoscopic surgeon because now I can look anywhere in your spine through this tiny hole and know everything that's around there. And that's what makes us, you know, so good at, you know, getting the camera down to the spot, but also knowing where not to go around the spine. And I actually had a discernion myself. In fact, I had the advantage of having this discarniation after I graduated, residency training and fellowship training. So my first thought was, who's the first endoscopic spine surgeon I'm gonna call? And the realization, you know, just fell upon me so heavy that no one else has the luxury to think about that, right? You know, I could make a phone call and say, hey, um, can you order me this MRI? Because I know I have an L5S1 disc herniation on the right side. It's compressing my S1 nerve root over here, right? This is exactly what I feel. I know what's gonna happen, I know what medications to take, I know how long I need to give this, and I know if I need surgery, and I know when that decision is going to, you know, come upon me that I have to make a decision on surgery versus no surgery. But like, you know, all these things I can process immediately, but for literally everyone else who's not a spine neurosurgeon, specially trains endoscopic spine surgery, they can't. They don't have that luxury. And, you know, when we started the Endoscopic Spine Institute of New York, it started around this surgery, but it turned into so much more, and we'll obviously get into that. But you know, in fact, the smallest surgery in the world and being the best at it is this much of what we do in our institute. So um, I don't know how many how much time we have for this thing, but um, I think three hours is a safe bet.

SPEAKER_01 9:10

That's up to you guys. When did you start the endoscopic spine institute of New York?

Building ESINY And Patient Access

SPEAKER_03 9:17

So we started the institute last year, okay. So we all were doing endoscopy. I was doing it for eight years, and Albert obviously for 20 years plus, and we're all in these different places. And what happened was we noticed a void in the spine surgery market, right? Meaning, and what what's the market when you talk about healthcare? It's the patients, right? The patients needed something better, right? When most of spine surgery is done for quality of life procedures, meaning when you're hurting bad and you you're you have a significant impact on your quality of life, you want to get a procedure to feel better. If that procedure hurts more than how you're feeling now, then what's the point of that, right? So we noticed that no one was offering endoscopic surgery to 100% of their patients, right? And Albert has he'll tell the story, but his his family is all in New York, his kids are in New York, and um I think that he got a little homesick and he wanted his kids to, you know, uh live with him and he wanted to be around his children. I grew up in Brooklyn, so all my family's still in New York. And my brother actually is closer to Philly, he's in he's in Mount Laurel, New Jersey. So um, I wanted to come back northeast and um we built this institute together, and it's it's turned into something very special. I think better than anyone of us could have predicted, as far as like the the the how how we prioritize what made this institute important and impactful to our patients.

SPEAKER_01 10:52

And you don't just limit your patients to local patients. I think I've I saw on your website the furthest people have traveled is 500 miles to come see you.

SPEAKER_03 11:02

Average. And it seems like and it seems like that distance is getting bigger and bigger. And it's not, we're not limiting it at all, right? And anyone who so there's a you know, the question is like who's perfect for this procedure? And it's it's literally so it's if you have a discreation and you and you've been told that or your MRI shows that, call us and let us know. If you're told you needed a big surgery and you're scared of that, call us, let us know, we can talk about it. If you've had a surgery before and you still have pain, or if you have pain again, call us, we can take care of that. So it's not that everyone is a perfect candidate for endoscopic surgery, but if you are, uh you're probably gonna be determined uh from our group. Because if you're not, um you if someone told you you're not, you should probably check with us first.

SPEAKER_01 11:52

Now I had my microdisectomy in 2019. And then several months ago on one of my videos, somebody commented, why didn't you get an endoscopic procedure? And my initial reaction was, uh what's that? I thought I thought I got the most minimally invasive procedure available. But that doesn't sound like that's the case, and it hasn't been the case for a while. Why do you think not so many doctors offer endoscopic?

Who’s A Candidate And Travel For Care

SPEAKER_03 12:21

Wow, what a question. It's it's a really good question. And we get it all the time because our all our visits are an hour long, right? So it it happens very frequently where we get to a part in the uh in the in the visit where the patient runs out of the questions to ask, right? So we heard them, we heard it all. So a lot of the times people ask us, wait, wait, wait, is this a real thing? How come no one told me about this? How come no one's doing this? Why are you guys the only ones? Why do I have like all these questions around like if this is a real thing and it's so it's as good as how you say, how come not everyone is doing this, or how come I can't even find it on Google? We've solved that problem, by the way. But um it's multifactorial. And the biggest reason is in American healthcare, surgeons get paid for the work they show, not the work they save. Okay. So if LeBron James steals the ball, runs full court, does a three 360 windmill dunk and makes it look easy, he gets paid more for that, right? If Albert and I make surgery easier or make it look easier, it seems like it's less work, so it gets reimbursed less. So there's very little incentive for surgeons. I'm not saying surgeons are bad and they do big surgery to get more money. I'm just saying part of the answer is in this system, there's very little incentive to innovate and to progress to make surgery smaller. It's very hard to do that and make that sustainable. That's probably the quick and dirty answer. That's probably number one or close to the number one answer. The other thing is it's hard to do. Okay. So, you know, I trained in again, maximally invasive surgery, right? Big, big open surgeries, and it made me a better ultra-minimally invasive surgeon. So it takes years and iterations. I mean, Albert has taught both of us have taught like countless courses for endoscopic surgeons, and Albert has probably seen most of you know the trainees, which are spine surgeons, trying to learn endoscopic surgery. And I don't, I mean, from Albert, from your experience, how many people are able to grasp sort of like this uniportal? So that so that it's a camera with a with a working channel in it. So you can't move the tool by itself. And surgeons are used to using two hands and an open surgery. So when you restrict it down to one tube, that changes the type of surgery altogether. And it's just the very, it's a very difficult thing to grasp.

SPEAKER_02 14:58

Yeah, it's a difficult, difficult skill set. We were just talking about it today. That when I would teach people, you know, I could tell within a few minutes, oh, they're not good, they won't be good. And other people like, oh, that their gift, they have the gift. Right. And like Sanjay says that, you know, nobody knows spine anatomy more than an endoscopic spine surgeon, right? Because we we operate through an incision the size of a pee. You know, we have to go down and do our work through such a small hole. And what he said about incentives, uh, you know, I had a uh clogged pipe in my living room, and somebody came by, and this is a true story, right? You know, they they said, Well, we're gonna take down the living room wall, we're gonna bring in a backhoe, we're gonna dig it up, and we're gonna put a new pipe down. And I'm like, Oh my gosh, I couldn't believe it. I couldn't believe it, right? And then, you know, I got a second opinion, and then the guy literally went out to my patio and took a tile off, drilled a hole in the pipe, and then through a scope, roto-rootered the pipe, blew up a uh a plastic bag, and then injected epoxy to create a new pipe, and then put the tile back, right? And so, you know, uh technology has changed, right? So there's plenty of still contractors out there who did it the old way because it's very hard to learn the new way. So, you know, currently in the United States, there are virtually no programs that teach residents how to do an and how to do endoscopic spine surgery. So 99% of programs are graduating surgeons who've never seen endoscopic spine surgery. So, yeah, we're just so far. Yeah, we just combined the best endoscopic spine surgeons in one place and then started to tell people about it. Look, you have an option.

Why Endoscopic Isn’t Everywhere

SPEAKER_01 16:50

That's great. You brought up Google. So, you know, when I Googled endoscopic versus microdisectomy, I came across an article where the the writer seemed to be dismissing the need for endoscopic because the outcome is the same, was what he was presenting. And my initial thought when I read that was well, this person has never had back surgery. So I'm wondering if you could go into the major differences between endoscopic and microdisectomy for just Joe Smo on the street trying to make a decision for themselves. Uh, how is the procedure different? And what are you seeing as far as recovery goes?

SPEAKER_02 17:33

I have to jump into this one thing that we're always telling patients, you know, if you have a pebble in your shoe, you know, you can just take the pebble out or you can cut your leg off. Well, the outcome is the same. Go ahead, Sanjay. No, no, no. That's exactly what I was gonna say. No, the outcome is the outcome is it, but I'm you know, CK, you know, for you, it's just like uh a microdyskectomy is a great surgery. And the outcome, you know, is the same with endoscopic spine surgery, right? The the print and we've written all the papers on this, all the scientific publications. And so the risk of that surgery is 16 times lower if you have it done endoscopically, and your return to work in life is much, much quicker, right? So we recently did one of the UFC MMA fighter champions, right? He was fighting two weeks later. You know, we do professional number one draft pick for the NHL, NFL play, right? And they're able to play much more quickly. But the big thing is reducing the complications by 16 times, you know, the complications for a microdyskectomy infection can be devastating, spinal fluid leak, devastating, nerve damage, devastating. So the margin of benefit really, if you've had a successful microdyskectomy, you know, it's but the problem is there are those complications. And should you ever need surgery again at that site, that's when it becomes more complicated, right? And if you have it endoscopically, it's much less complicated if it happens again.

SPEAKER_01 19:10

So, how is the procedure itself different, besides you know, a smaller incision?

SPEAKER_03 19:16

So it's everything has the same title, right? A microdyskectomy is a surgery, right? And how you do that surgery can be done many different ways. It could be open, it could be done minimally invasively, if you think about like a roll of toilet paper, the end of the toilet paper, that cardboard roll, and then uh endoscopic surgery. They're all microdyskectomies, it's how you do it that's different, right? Right. And we always talk about the incision because it's the closest thing that you can just think about, just to compare how small it is. And it's literally, you know, the size of my pinky nail right here. It's like eight millimeters. And but that's just the tip of the iceberg, right? The incision is just the optics of the whole thing, it's the collateral damage that the surgery does. Because again, as you know, all surgery is damaging, right, to the body, right? So if you can accomplish that microdyskectomy and leave without a trace, then that's the most preferable thing. So that's why it hurts less. People are getting work back to work faster, they heal up faster, they have less infection, less rate, less less uh blood loss, less length of stay in the hospital. That those are the actual numbers for endoscopic versus any conventional microdyskectomy, even a tubular or supposed micro uh minimally invasive microdyskectomy. So all a microdyskectomy is is taking out the disc herniation that's pushing on the nerve. So it's not taking all the disc out. So if you take all the disc out, you'd have to replace it with a graft or a disc replacement device or something. All everyone is doing is taking that herniated disc component off away from this nerve and freeing that nerve. That's a microdisquectomy. But if I had to take off all this muscle to unroof this, to find this, to move the nerve to the side, and then take that out, that's an open or conventional approach. We stick a small camera down here, get right to the disc, and then through this camera that's quite literally the size of my finger, put another instrument through a working channel here, and then pick, pick, pick, remove that disc herniation to allow that nerve root to be a little bit more free, then take the camera out, and all the tissue actually naturally collapses on each other and heals by itself because we don't split the muscle fibers, we just go through them with the uh scope. So it's a very, very different procedure, and it's it accomplishes a microdyskectomy, but how you do it is dramatically different.

SPEAKER_01 21:45

Right. I feel like the muscle involvement with the microdisectomy, the cutting it, is what can make recovery so difficult. At least that was in my case.

Microdiscectomy vs Endoscopic: Risks And Recovery

SPEAKER_03 21:56

No, absolutely, and it has it has long term effects as well. Well, because if you're replacing what used to be muscle with scar tissue and fat, then it's just not structurally as sound as it was, right? And that's not because you had the discarniations, that's because you had the surgery.

SPEAKER_01 22:12

Right. Right. Now I think most of us patients are used to the a disc is like a jelly donut. Uh, but I was wondering if you could just go into disc herniations. Are they all the same or are they different? And do some qualify for endoscopic while others do not?

SPEAKER_03 22:33

So the short answer is they're all different, right? And it's really less about the disc and how it looks on pictures and more about how you feel as a patient, right? So there's categories, how it looks and how you feel. Okay. So let's take how it looks. So there could be a disc bulge, which is just a bulging. If you take that donut, it's the jelly just pushing on the outer rim of that donut and not squirting out. And then you have all the way up to a sequestration, which is squirting out and going somewhere else and irritating a nerve root and making a home somewhere else where it's not supposed to be and causing a really bad problem around a nerve. And there's everything in between, it's pushing out a little bit, pushing out a little bit more, prolapses. These are all ways to describe how much of a disc herniated. And that's just on the picture because you could have any clinical scenario with any of those things, right? You can have a sequestration with a big, big disc pushing out really like significantly on a nerve route, and a patient can have no symptoms. So you have to put together how a patient feels with what the picture looks and make a decision from there. So, no, from a morphology standpoint, because they can look and be all different sizes and shapes, but also from a location standpoint, they could be right side, left side in the middle, they could be broad based, they could also be super soft, which is a new disc or acute disc, or they could have been there for a long time. So the body makes bone around it, which we call a calcified disc, which forms adhesions around the nerve roots. And they could also be in the lumbar spine, the cervical spine, or the thoracic spine. In the cervical and thoracic spine, they have your spinal cord around them. The spinal cord controls everything from that level down. So it's a more serious type of disc herniation that can cause longer-lasting irreversible problems. So just because you have a disc herniation somewhere doesn't mean you need surgery, but it also doesn't mean, oh, I just have a disc herniation. So it all really depends on how you feel. Now, if you have no symptoms, usually you don't need surgery on it.

SPEAKER_04 24:36

Right.

SPEAKER_03 24:37

And if you do need symptoms, obviously you have to talk to someone to sort of iron that out. Um, but that's also why all our clinic visits are an hour long, right? You can't possibly get all the information you need to to make a decision on whether someone needs surgery or not in a traditional five to 10 minute clinic visit in a you know local hospital or university. It's just impossible, right? To make that decision in in such a short time.

SPEAKER_01 25:06

I love that you say treating the patient and not so much the MRI, because I am astonished at my MRI, my herniated disc looks like a little tiny thumbprint and it dropped me to the floor. I was in so much pain. And then I see people with what looks like a golf ball, and they're like, ah, it's a five. Oh my god.

SPEAKER_02 25:26

CK, so uh my fourth herniated disc, I was on the floor telling my wife to call an ambulance, and I got my MRI, and it was the world's smallest herniated disc. The world's small teeny tiny disc. A little embarrassing, isn't it? Well, well, you know, so but you know, somebody people a lot of times patients don't get the information. Like you're saying, a jelly donut, right? The the donut part is like an onion, right? So onion layer after layer after layer, and the inside, the jelly, that's the shock absorber. So if you tear the onion, which is very painful, and then leak out that little bit of jelly, like my last disc, that jelly feels like a nuclear bomb went off in your back. It is so inflammatory to the spine, right? At that point, when you have that, you know you would do anything. Just, you know, cut cut my back off, you know, do whatever it takes. But yeah, that that's the part where you know it's like it's not, you know, it's not the size, right? And it can be a big disc, but it's still covered by a little bit of the donut, the onion skin, so it's not as inflammatory. And we see that all the time, where you know it's ruptured but still has a skin over it, and that's why it's not as painful.

SPEAKER_01 26:41

I have to ask, what are you doing that you've herniated a disc four times?

Discs Aren’t Donuts: Pain And Inflammation

SPEAKER_02 26:45

Yeah, so I I I finally uh, you know, um, so it was a big deal for me because it was ruining my life. It made me um, you know, I I I didn't want to go out to dinner. I would I you know going for a walk, you know, I'd be crying after a block. And I gained, you know, people will tell you, it's like you ever her need a disc, you gain 20 pounds, right? Just because you don't walk as much. You're not eating more. You can you know, and so, but finally, you know, like I, you know, I'm from a different era, you know, with that. If I worked out, I meant, you know, I did bench press or something, and then I finally went to physical therapy and I learned how to do core and back extension strengthening. So your core, this is you're like a skyscraper where your spine is the steel girders and your core is the concrete. I finally learned to take care of my core, and I have not had a problem, you know, in a in 15 years, right? And so uh, you know, I get up in the morning, you know, I do my core strengthening. Before I go to bed, I do my core strengthening, right? You know, it's just one of those things you turn 40 and you gotta take care of yourself, right? You know, and so that's what that happened a long time ago, turning 40, Sanjay.

SPEAKER_01 27:58

So when I herniated at my disc.

SPEAKER_02 28:02

Oh, oh really?

SPEAKER_01 28:04

Yeah, I kept telling people it's not because of my age.

SPEAKER_02 28:07

Yeah, yeah, no, but that's what you know, that's part of the rehab. And so, you know, we really uh we share that with patients all the time. You know, it's not just the surgery, it's the road to changing your life so it doesn't happen again. It's not physical therapy three times a week, right? It's three times a day. Yeah, it's like Spanish class. You don't learn Spanish, just go into class, you have to practice it. And core strengthening is like brushing your teeth. You got to do it every day, every day.

SPEAKER_01 28:33

So now, with the endoscopic procedure being such a small scope that you're looking through, how are you able to deal with maybe complications? My disc was uh kind of glued to the Dora with scar tissue, so I still have a chunk of the disc uh stuck to my nerves. Um, are you able to deal with complications like that or tear?

SPEAKER_02 28:53

So, you know, when when you used when you wanted to look at Mars, right? People used to build big telescopes, right? And so now, you know, we fly a little rover that's up there and we actually see what it looks like, right? So the old way of doing surgery, like with a microscope, you were two feet away from this tiny half-inch area. We our cameras are right there. So the first thing is that complications happen 16 times less, right? So it's so rare for us to ever have a complication. And then um we've we've written, I think, all of the papers on how to treat the complications, and you know, and because you're making such a small hole, a port to get there, if you were to have a tear in the dura, you you just leave a tiny sponge there and it seals up on its own, right? There's no way for it to get out, right? You know, and bleeding, you know, we we have little glues that we inject, stops the bleeding. We have a little quiet, we have a million things over there. Nerve damage virtually never happens, you know, because we can see what we're doing, right?

SPEAKER_03 30:07

That's by far one of the biggest misconceptions of endoscopic spine surgery. It's like, all right, well, if it's so small, how do you fix all the major problems? Mine is complicated. You can't really take care of that. I mean, that's not patients and everyone on the street saying it. It's spine surgeons that are saying that. It's like, and the people that do say that are not doing endoscopic surgery, endoscopic spine surgery because of all the points that Albert mentioned, right? The optics, you're you're this close to the nerve with the camera, and the screen is this big, right? You can't get any safer than that. And we have all sorts of different types of instruments, drills, graspers, uh, dissectors, all these different shapes and sizes, just like open spine surgery, just smaller, much smaller, the size of a grain of rice, literally. Like that's how tiny these things are.

SPEAKER_01 30:55

One of the pushbacks that I often see for people considering surgery is people will say to him, say to them, don't get back surgery, it just leads to more back surgeries. Would you say that's true, or is that a carryover?

Rehab, Core Strength, And Prevention

SPEAKER_02 31:12

That you know, I I I agree with it, right? Letting the genie out of the bottle, right? You know, and so you know, if you know, if you have um a uh worn-out tire, right? It's like and you know, they tell you it's just like, oh my gosh, uh, you know, this tire, it's gonna go bad, you know, in 20,000 mile, you need all four new tires, right? And that's how so many people get big back surgeries, right? You know, they go in to see somebody, oh, we need to fix everything, and right, and so you know, you really want to keep as much of the disc you were as possible, right? And so if you have back surgery and you start removing disc, we only are born with so much disc, right? And so the odds of you getting better without a diskectomy, 90% of the time it happens. Of course, your body heals naturally. You squirt that jelly out onto your kitchen table from the jelly donut, you come back in the morning, it's just a stain. Your body does the same thing, right? So we reserve, even though it's endoscopic, we it's surgery. We, you know, you gotta try physical therapy, you know, give it at least six weeks to try to get better, and maybe you can avoid it. And we do it all the time. We do it all the time.

SPEAKER_01 32:36

So you'll you'll see patients and say, let's wait, or I don't think this quite qualifies for surgery just yet.

SPEAKER_02 32:44

Well, so we have we have one rule. It's like we're really good surgeons, but we don't think with our heads, we think with our hearts, right? Treat every patient like our own family. You're my spouse, you're my son, and this is how we do it. And it's just like, okay. And of course, if we have to do surgery, the smallest surgery possible, right?

SPEAKER_01 33:04

Are there symptoms that you say, no, absolutely, we need to get you in for a surgery now?

SPEAKER_02 33:10

Yes. Yeah. People come with a new foot drop when they can't move their foot, you know, we have to, you know, and then people always they know about coda aquina syndrome, right? When you have such a big disc, you know, it it can affect your bowel and bladder function. That's uh we call these red flags, right? You go skip the line, go to surgery.

SPEAKER_01 33:33

How is the recovery different from a microdisectomy? Or is it still the same restrictions? Is what I want to ask. Is it the six weeks of no bending, lifting, or twisting?

Managing Complications Through A Tiny Portal

SPEAKER_03 33:42

Absolutely not. Um the jury is still out for that, just from a purely study publication paper standpoint, where our group is actually looking at that. Um, and what we say is just take it easy for the first one or two weeks. And that's like super aggressive, right? Albert's like, ha ha ha, you can go skiing tomorrow, right? Like we we differ a little bit on that, and we're actually obviously because we differ on that, we're trying to standardize that because we need to learn from that, right? Because patients recover faster, we're you're you're not laying in bed for six weeks, you're not like not lifting your child for six weeks. It's not people are going back to work. We operate on surgeons all the time. We've operated on probably 40 or 50 spine surgeons.

SPEAKER_02 34:31

So when they did one today, we did one today.

SPEAKER_03 34:35

Um, but we operated on a on a surgeon from Chicago, for example, on Tuesday, and he flew back the next day and did surgery on one of his patients on a Thursday. So it all it's all about quality of life, how you feel and how you tolerate the procedure. Everything's patient-centered and super individualized. So, whatever you want to get back to, we will try to get you back to that. Now, if your job is working for the pink truck moving company that's you know moving, you know, a fridge the next day for somebody, we're gonna tell you probably don't do that tomorrow if you had a lumbar disc resection uh endoscopically or otherwise. Um, but uh you can go back to whatever your occupation is as long as you're not heavy BLTs bending, lifting, and twisting, right? The data shows that too.

SPEAKER_01 35:26

Really? I have seen in the um Reddit group more and more people saying, Hey, my doctor said live your normal life, just don't do anything extreme. So doctors are starting to lean that way, it seems.

SPEAKER_03 35:40

Absolutely. And and it and it makes sense sometimes too, because you know, the disc rehanniation rate is anywhere from like five to ten percent. So if it does happen, it'll happen early. And as a surgeon, you kind of want it to happen earlier because it's much easier to get in there and do another, you know, disc uh microdyskectomy if there's more disc material to take out. And that's like the conventional thought. But with endoscopic spine surgery, it would leave so little scar tissue behind that that's not a real concern. Wow.

SPEAKER_01 36:12

One of the hardest parts for me with my microdisectomy was that I was not prepared for the recovery process. Uh, there were so many odd symptoms. Uh, the there was PTSD and anxiety, the aches and pains, and and I just felt super un underprepared by from my surgeon. How do you manage expectations of your patients for recovery?

Do Back Surgeries Lead To More?

Red Flags And When To Operate Now

SPEAKER_02 36:38

You know, I I think I you know I did a uh uh a TikTok on this where you know it was Sunday and I was making pasta bolognese. I cook on Sundays, that's the day I cook for my family. And I got an email from a patient of mine who lives in Texas, and she was really feeling down, right? And I called her immediately. I I've had seven surgeries, right, in my whole life, and I'm half Irish, and every time I have surgery, I get so depressed. I mean, like whatever I was having surgery for, I felt better, right? But I was so like, I mean, like the edge, you know, of everything depressed. And you know, and I called and I said, look, this is you know, this is what goes on. Your body is shifting its energy to healing, right? And you're a caveman, you break your arm. They want your body wants you to hide in the cave and recover, not feel great and go out, you know, and all these things, right? You know, and I think, you know, like one thing all our patients have our emails, right? We're always in contact with our patient, right? You know, it just like, you know, I think this is something been lost in medicine that your patient is a person, right? You know, and it's like it's not just your patient's not just a L5S1 or L45, it's a person, right? You know, it's like, what do you like to do? Do you have kids? You know, and yeah, it's like who else needs you around the house? And you know, if it's a woman, I'll be coaching the husband. I need you to step up, bud. I need you to, you know, help around the house for a couple weeks. What's your rapid fire to your uh to your visits? Oh my, so it's so this is my so I I I went to a very good medical school, right? And in med school, I learned just to say, so what's going on? And I just listen. Just listen. Patient carries a story for a long time and finally has the guts to go see a doctor and to and no patient wants to hear, uh-huh, and where are you and how much do you weigh? And do you some all these questions? Just like, how do you want to get your story out, right? And you listen and listen, you know, and then after I listen half an hour, I do the uncomfortable rapid fire where so what'd you go to high school? What sports you play? How'd you meet your wife? Do you have a dog? What's your dog's name? What do you do for fun? Right. It's like the getting to know my patient. It's like as a person, right? It's but you become you want next time I see you in the office, like, oh, how's Benji, your dog? Right. It's just that you're a person. Oh, you like to play golf. Oh, you like to go surfing. Oh, you know, what what is your life? You become I have a memory box that you live in now that you carry with me and stuff like that. And I think that's that's one of the things like why we practice the way we do, because we really like it. We have a very personal relationship with our patients, you know, that we know them as people. And I think a lot of that anxiety, right? So anxiety comes from when your brain tells you over how about the danger, possible dangers, and then undersells the possible good things, right? So you have a disc surgery. Oh, what if I, what if I can't get back to do what I wanted to do? Oh, what if I re-da-da, and not like, oh my gosh, I'll be better than ever, right? But it comes also from being alone, right? You're carrying this, you don't have somebody you feel is riding in the sidecar of the motorcycle, right? You know, so our patients today, we tell them, look, we emailed you the video from your surgery, right? We're gonna call you tomorrow morning, go over everything again, and you have our emails. Anything comes up, you ask us, right? You're not alone, right? So a lot of that, you know, is just the because you're you're CK, you're a person, right? You're alone with something that you don't know about, it's scary, you know, and so not to carry that alone helps with some of that anxiety, you know, reduces that PTSD. So I we we made a TikTok of you have a guy. I have a guy. If I have a problem, I have a guy, I'll call him. I don't have I don't have car anxiety if I have somebody who takes care of my car. I'll just call my guy, right?

SPEAKER_03 40:48

So Christine, how long was your uh pre-op clinic visit?

SPEAKER_01 40:53

Oh, I don't remember. My husband probably remembers more than I do. Um it was quick. I I, you know, you somebody said earlier that you just will do anything to get out of pain. And I chose a doctor by who can see me the fastest and get me in the fastest.

SPEAKER_03 41:11

Yeah, yeah. And it's it's the the problem that most people fall into. You go see a specialist, you get a specialist recommendation, you get a special surgery, and you think, all right, well, that person probably knows all the options, they're probably getting the best option here. And you know, the fact of the matter is, unfortunately, it's not like that, especially with spine surgery. And um, you know, with elective procedures, pain sort of is in this weird category, right? Because when you're so miserable in pain, it's not elective to you, right? So you kind of want to get it taken care of faster. And it puts it puts patients in a very vulnerable position, it does.

SPEAKER_01 41:51

Are there questions that you think every herniated disc patient should be asking when they're considering surgery?

Recovery Rules: Beyond BLTs

SPEAKER_03 41:59

Yeah. Do I really need surgery? Can this be done on the SCOPEC? And what would you get if if you had this problem and you needed surgery?

SPEAKER_02 42:07

Oh boy, that's so we we have gotten a number of patients referred to us because they asked their surgeon at their home state, what would you do if you were me? And that surgeon said, I would go see the guys at ESINY. That's what they were honest. The surgeon was honest, that's what they said. You know, they were like, that's who I would go to, right? You know, and have it the smallest way possible. You know, and I I don't, you know, even though what we do is small, what we also do is we handle the most complicated cases in the country, right? Like the most dangerous kinds of herniated disks because our cameras are so small, we can go through very we call it the margin of benefit, where we can go in and instead of somebody needing to be in an ICU, they're out to dinner that night, you know, in New York City. So, um, so it's uh it's a high stakes game, you know. And if you can go in with a it's like uh Jenga, right? We can slip in and you'll never know we were there, right?

SPEAKER_01 43:11

Right. Now, would you say if someone is told for the first time you need a fusion, should they kind of contact you and get a second opinion?

SPEAKER_02 43:21

Oh yeah, all yeah, that would be that's sort of you know like the biggest service we can do somebody, right? You know, that that that's what it comes down to. Like I used one analogy, like you know, if you have a terrorist in a building, you know, you can blow up the building, or you could just get a sniper and shoot the terrorist, right? You know, the the fusion, it'll it can take care of a herniated disc, right? It will, you know, but the rest of your life you're gonna have issues related to that fusion, you know. So if you can avoid it, you know, and and historically fusions were meant for people who broke their backs or you know, had so many disc surgeries that they couldn't have a disc surgery anymore. And and so they're just

Setting Expectations And Patient Support

SPEAKER_03 44:00

you know they're wildly popular now and uh ne neither I can speak for both of us that would be a last resort for both of us so right I am grateful for my microdisectomy and I would never talk somebody out of getting a microdisectomy but I really appreciate what you guys have to say is there is there any other aspects of endoscopic uh surgeries that you want to impress upon the listeners so in general endoscopic spine surgery is the smallest spine surgery you can get today okay number one before endoscopic spine surgery it's no surgery right so if you're gonna get better without surgery someone has to tell you that and the hope is that someone will tell you that if there's any other if there's any question whatsoever we people DM us okay like this is not you don't have to schedule an an appointment at that point right we answer Albert is in the doctor's lounge dictating replies to DMs while I'm typing notes or while you know and vice versa we're always in action right so you don't have to wait we have patients from Canada messaging us all the time I have to wait six months to get into a spine surgeon meanwhile they're scared because they have their report in front of them and they're just like waiting right when the point I was getting to before is that we started this institute on the basis on the backbone of this surgery right but what it turned into was so much more because what patients are getting are access to both Albert and I 247 right you have surgery from us and you have our email and our phone number and you can call us whenever you can email us whenever right so if anything ever comes up you can always reach us. And with endoscopic spine surgery it's just inserting itself into this whole algorithm of spine care right so of course time medications physical therapy massage therapy aquatic aquatic therapy acupuncture then maybe it's some injections that can help you targeted injections remember they can be both therapeutic and diagnostic. So if you're getting a surgery especially if you're getting a super specific surgery we could you know probably get an injection first to try to see if we can target that nerve specifically or if we should target that nerve at all right and before endoscopic right after the injection all you had was big bad surgery open or minimally invasive you know fusion or otherwise right we are we are this half step before the conventional traditional surgeries. So in fact if you're told that you needed any other surgery that's not endoscopic you actually need to see if endoscopic is an option for you. But the problem is most people don't know how to do a lot of these procedures endoscopically so they'll say it's either not possible or actually too dangerous or contraindicated, which means you shouldn't do it because it's impossible to do or be too dangerous. And those are the exact patients that seek us out because it's like hey you guys said endoscopic is an option for all this stuff and we've actually actually asked my doctor and he does endoscopic and said it's not an option but when we say it we're like this is a perfect case right the problem is right now endoscopic spine surgery we've made it so popular that people are putting it on their websites. Okay so and we again we have this is a real story too patients are coming to us saying like you know I felt like it was a bait and switch because I went to the surgeon who marketed themselves as endoscopic spine surgeon and then they offered me a regular surgery. And then when I come to you guys it's like a no-brainer so first of all there's doubt because it's like why why are you guys saying it's so easy to do and why you're saying it's possible when these guys told me it's not and unfortunately that's kind of where we are in this funny period in spine surgery where you know people want to say they do it but can't really do it and don't understand what it is because again even spine surgeons are saying it's more dangerous to do it endoscopically meanwhile we just clearly stated that it's like the safest way to do any spine surgery. So it's in quality of life that you just want to march up right from conservative management to from the least invasive to the maximally invasive. And it's just a a step before the normal surgery that's what I would say. So in general if you're signed up for a surgery at this this is also true stories people cancel their surgeries get appointments with us and we either tell them they don't need a surgery or they can have an endoscopic approach. And this is like 50% of the patients that come you know ask us questions.

SPEAKER_01 48:42

What other uh spinal conditions do you treat with endoscopic we've only been talking about herniated discs.

Questions Every Patient Should Ask

SPEAKER_03 48:49

So herniated discs right so herniated discs is just a thing that's taking up space that's pushing on a nerve that's that could be a disc that could also be a bone spur. So if you have degenerative disc disease and that's anywhere in your cervical thoracic and lumbar spine that's a thing taking up space okay you can have a cyst that's a synovial cyst or any other type of cyst taking it's another thing. All we do is remove something that's pushing on a nerve that's taking up space. That can be a disc, a bone spur, degenerative disc disease it could be a small benign tumor um it could be just uh um joints closing down on each other which also narrows that tunnel um it could also be scoliosis. We're not fixing the alignment and Albert and I talk about this all the time. No one's talking about hey my alignments messed up they're talking they're coming in for nerve pain. So when when uh when you have scoliosis you're leaning towards one side that closes up the space that the nerve exits and you can have ridiculopathy could feel like a disc herniation. We can also put a camera down there and make the space bigger without a huge scoliosis deformity correction that the patient may or may not need so um those are the types of and we also do a handful of other things that you know we also publish on that we're trying to understand the the the perfect um indication for and um and and and post-operative workup um which are like things like spinal fluid leaks people can have spontaneous spinal fluid leaks and the conventional way of doing this is doing an open maximally invasive exposure and typically they happen in the middle of the spinal canal which the thoracic spinal cord is and you have to work around it you can't retract the spinal cord or they'll be paralyzed so that's a big big dangerous surgery where we change it to an outpatient procedure same way we get down to the discs we get down to the the holes of the dura where they have spinal fluid leaks and we patch it right up with the with the camera procedure too.

SPEAKER_02 50:53

So I was Chrissy we you know we're the first people in the world to do a spine tumor endoscopically fix a tethered cord endoscopically you know thing after thing after thing you know we're we're we've always been the first ones to treat these kind of things and figure out smaller better ways to do everything. But by far the most common thing we do is treat pain you know and so people have a pinch nerve.

SPEAKER_01 51:19

I meant to ask earlier when you're doing the endoscopic for herniated disc, are you able to avoid removing bone or do you have to do the laminectomy as well?

Second Opinions On Fusions

SPEAKER_02 51:28

So it's it depends on the person and their anatomy so and the level right so L5S1 has a big this is what we said about knowing anatomy right so has a big interlamar window. So a lot of times we could just sneak in zero bone removal slip through the leaves of the ligamentum flavor them drop a camera pull out the disc and that's one of the things was does size matter? Huh a big disc should be hard but in that case it's so big it's so easy we drop right in we just take it out right so there are cases where we can do virtually no bone removal or no bone removal so it's a you know it's a super holistic way to look at surgery and people right so behind all this is we believe life is meant to be lived right we're not trying to you know show x-rays oh look at the beautiful 18 level fusion I did we want our patients moving right that's you know what what it is and you know and we we we call our patients in the I called a a state senator this morning that I operated on you know that flew to New York and um uh another lady uh um flew from Texas and and it's so they're so excited they're so happy and we we finish the calls and we know they're gonna forget us so quickly which is what we want we want the right I wanted to let you both know that your passion and your energy for for this procedure and for your patients just comes across so clearly on your TikToks and you you are an amazing partnership and that also comes across that I've worked at practices where the doctors just don't like each other and and just you lose trust in practices like that.

SPEAKER_01 53:20

But your your love and your passion for your patients is so clear on TikTok and that's why I just had to ask you to be on the podcast.

Endoscopy As A Step In The Care Ladder

SPEAKER_03 53:29

You're so nice. That's awesome. That's that's so nice for you to say I mean we do talk about like why why aren't other people doing this and it's one of them it's like you can't get two nourishers and to work nicely in the sandbox together and and you know we have fun doing this right and that's that's the real sort of like baseline you know benefit to all this is number one we spread our passion towards our patient our pay if we're not if we're miserable our patients are going to be miserable. Our families are going to be miserable right everything around us is like flourishing now because we're able to do what we love to do. It's 100% endoscopic spine surgery and because of that again it just like branches out into all these things we just get to be human again. We're having fun right and that's why we're doing the TikToks that's why we're doing the the the social media the Instagram the Facebook the everything the YouTubes even this right doing that brought us to you and all the work that you're doing. And you know we would never get exposed to this kind of stuff if we're just like you know you know tied up white coat in a 15 minute clinic visit we're not learning about our patients right this is getting down to the the what matters and um you know I would argue that the work you're doing is much more impactful than majority of spine surgeons across the country. I mean at the kind of you know the videos you have and the instructional um videos before in the perioperative period in general is um it's something to be proud of and I think I'm I'm not kidding when I said you know I'm gonna I'm gonna start linking you know your your YouTube to to all our patients because it's important to know right we're not over here they know what we're able to do. So they come to us and ask us questions and then decide from there right um and it's it's a very different experience for them because they just get to talk it out and and we're here and you know we're just you know we had a bad blizzard right in um in New York City and obviously you know that's why we're we we're meeting today actually so you know we had surgery scheduled in the hospital um in Manhattan and big manhattan hospitals are are canceling surgeries so we had a couple surgeries cancel and people were from out of state right so they had hotels and um you know they they're they're prepared for their surgery their family's here with them they had to you know get make some you know um uh reservations at places and they they had to get help at home while they're away and it's a big big thing to come not only to New York but to have a surgery and to play I mean you know this right to plan the days before and the plan the days after if you had to do that all over again because you had to fly back to New York City and get a surgery because your surgery was canceled it would be a big thing. So we got her on the schedule before her flight out right so we're able to get her surgery done before she left. So we're doing that not because you know we you know we had an opening right we're doing that because we recognize the impact that this has on someone's life and if we could facilitate that while having fun it just makes sense. It's just easy to do it's a no-brainer right that's amazing Dr.

Beyond Discs: Spurs, Cysts, And Leaks

SPEAKER_01 56:51

Sanjay and Dr. Albert thank you once again for taking time to come on to the Bed Back and beyond podcast it's a wonderful name by the way we love my husband my husband came up with it so he gets the credit and he's he's the uh voiceover in the beginning that's awesome that's awesome he's my partner he took such good care of me when I had my procedure uh the unsung heroes of the whole yeah yeah I couldn't have done it without him but uh I really appreciate you guys coming on and just taking the time to speak with me and for my listeners they're gonna I think walk away with so much important information this was awesome thanks for the opportunity um I've already joined your your Reddit so um I'll be I'll be uh stalking that quietly you'll see the video posted in a couple days maybe a week I'm not sure yet if you are a listener and you have a positive story of recovery from a spinal injury head over to bedbackbeyond com and click share your story I would love to include your voice on the show. Once again doctors thank you so much