Endoscopic Foraminoplasty:

Endoscopic Foraminoplasty consists of undercutting of the facet joint and endoscopic discectomy, freeing of the exiting/ transiting nerves, and shaving of the disc osteophytes through one or more small incisions utilizing a scope. The technique was developed by Dr. Osman in 1995. It involves ipsilateral, biportal transforaminal endoscopic approach with decompression of the lumbar and thoracic spine. Additional procedures including interbody fusion and pedicle screw instrumentation may be performed, depending on the patient’s need.

Endoscopic Interlaminar Discectomy:

By utilizing a scope, the precise placement of instruments in the interlaminar space allows for accurate removal of the herniated disc nucleus, resulting in minimal disruption of soft tissues compared to traditional invasive surgery. Also, a single (uni-portal) or unilateral, double (bi-portal) approach may be used to remove the thickened ligamentum flavum, laminotomy, and removal of the hypertrophied facet joints. This is particularly helpful of the elderly patients who may have comorbidities.

Endoscopic Lamino-foraminoplasty:

When there is a severe spinal canal and foraminal stenosis, a transforaminal or interlaminar approach alone cannot fully decompress the segment without the risk of too much bony removal and destabilization of the segment. By utilizing bilateral, tri-portal endoscopic (BTE) both spinal and foraminal canals are decompressed with minimal trauma while minimizing the risk destabilizing the motion-segment.  Dr. Osman developed the technique, after he created the anatomic image-based classification of the spinal motion-segment pathology in 2014.

Endoscopic Medial Branch Radiofrequency Ablation:

Through the assistance of a scope, the physician uses x-ray guidance (fluoroscopy) to direct a special (radiofrequency) needle alongside the medial branch nerves. A small amount of electrical current is often carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the neck or back. The targeted nerves will then be numbed to minimize pain while the lesion is being created. Radiofrequency waves are introduced to heat the tip of the needle, and a heat lesion is created on the nerve to disrupt the nerve’s ability to send pain signals. This process will be repeated for additional nerves.

Endoscopic Transforaminal and Interbody Fusion:

Endoscopic Transforaminal and Interbody Fusion consists of a surgical technique through one or more small incisions, utilizing a scope and endoscopic instruments to decompress the foramen and the disc to free the nerve roots and the dura. Transforaminally, a percutaneous cage is then place in the disc space along with bone graft to fuse the segment. Percutaneous pedicles screws and rods are then inserted to stabilize the segment while the fusion proceeds. This combination of endoscopic decompression, interbody fusion and percutaneous pedicle screw implantation techniques was developed by Dr. Osman in 2003, and published in 2012.

Endoscopic Transforaminal Radiofrequency Annuloplasty: