I was borne and raised in a rural African community where a large number of people suffered chronic back pain and there was no adequate remedy. That experience led me to choose medical profession. After graduating from medical school, I went to Britain to study orthopedic surgery and later spine fellowship.
During my spine fellowship training I was concerned about the massive surgical trauma, blood loss, slow recovery, complications, and high cost associated with open spine surgery, especially multilevel decompressions, and deformity surgeries. During my orthopedic residency training I had learned and was good at knee arthroscopy and, after the experience with open spine surgery, I seriously started exploring the possibility of applying the endoscopic technology to spinal conditions. I came to the USA in 1992 as a spine fellow to explore that opportunity.
Dr. Parvis Kambin had introduced basic endoscopic transforaminal lumbar discectomy by early 1990s, and I attended a cadaver lab and live surgery sessions in 1993. I was very excited about the experience but was also very concerned about the lack of data which would help minimize risk of injuries to the nerve roots and the dura. So, we carried out our own cadaver study in which we performed transforaminal endoscopic discectomies in the thoracic and lumbar spine. That study revealed it was possible to perform endoscopic thoracic disc surgery safely.
In 1994 we performed the first endoscopic transforaminal endoscopic discectomy and interbody fusion on out-patient basis. The patient was a radiologist with paraparesis due to thoracic disc herniation. After the first case, based on my biportal knee arthroscopy experience, I developed ipsilateral (unilateral) biportal endoscopic thoracic decompression and interbody fusion. In 1996, I performed the first ipsilateral, biportal endoscopic lumbar foraminoplasty, using burs, shavers, curets, and other tools. The first patient was a retired ophthalmologist.
The challenge to transforaminal lumbar endoscopy was, in some cases, at lumbosacral junction where the height of the iliac crest prevented access to the L5-S1 disc. Initially, such cases forced us to perform open interlaminar approaches, but later we developed transiliac window in patients with high iliac crests and accessed the L5-S1 disc transforaminally.
The challenge to endoscopic remained in cases where there was severe spinal canal and foraminal stenoses. Transforaminal or interlaminar endoscopic decompressions were not able to address those types of lesions without risking destabilization of the motion-segment and other complications. So, we developed endoscopic lamino-foraminoplasty using simultaneous interlaminar and transforaminal approaches, and used burs and a flexible shaver to decompress both spinal canal and the foramina while minimizing complications.
We performed the first endoscopically assisted decompression, lumbar interbody fusion, and percutaneous pedicle screws (EDLIF) in early 2000s. This was before percutaneous interbody cages became available.
