The elderly female patient presented with bilateral radiculopathy and axial back pain caused by central canal stenosis, lateral recess stenosis, foraminal facet hypertrophy, and broad-based discal herniation at the L5, S1 level due to adjacent level complications brought on by subsidence and inflammation of the L4 vertebral body over the fusion device.
The first part of the procedure was started by addressing the facet hypertrophy using the transforaminal approach and was targeted using a 16ga. needle. The coaxial dilators and trephines were then used to start the foraminotomy. Once the foraminotomy was complete the working tube was placed in the patient followed by the endoscope open in the ventral orientation. The lateral aspect of the discal pathology was visualized and removed with a combination of pituitary rongeurs and the Triggerflex radiofrequency device. The working tube and scope were then rotated to face dorsally and the ventral aspect of the superior articulating process was visualized and the foraminotomy was augmented using high-speed burr and Kerrison rongeurs.
The second part of the procedure was then started by targeting the L5, S1 window using the one-step dilator. An incision was made and the dilator was placed in the patient and guided to the dorsal aspect of the ligament of Flavum. The working tube and endoscope were then introduced. The high-speed drill was then used on the medial facet and inferior lamina of L5 to decompress the lateral recess and make room for the working tube and scope. The ligament was then visualized and a defect was made using the Triggerflex radiofrequency device. The defect was extended using a combination of up-biting through cut forceps and Kerrison rongeurs. The working tube and scope were then moved ventrally into the epidural space. Using the working tube to retract the neural elements medially the rest of the discal pathology was removed and the lateral recess decompression was augmented with the high-speed drill.
This patient was staged and her primary surgery was done on the contralateral side in the same fashion three months prior to this surgery.
The patient is ambulating and is pain-free.
An endoscopic Facet Denervation can be a quick and simple procedure to relieve your patient of sciatica and back pain. This is to learn technique utilizes endoscopic instruments to target the pain generating facet nerve, with visualization through the endoscope. The Bi-Tip or Trigger-Flex combined with the Surgi-Max Ultra can be used through the endoscope to transect the nerve and alleviate the patient’s pain.
75 yr old male presented with 3 weeks of radiating left lower back pain and leg pain. He was in a 3 hour car ride and when he got out he had severe onset of symptoms. Pain was radiating into the left anterior thigh. He was a healthy active male prior to symptoms. The last 3 weeks he was unable to lay in bed flat and has been sleeping in a recliner. He was unable to walk more than 15 feet without severe pain. He began to use a cane, then a walker and presented in the office in a wheelchair. He had fallen three times due to left leg weakness.
The MRI demonstrated a L3-4 far lateral disc herniation compressing the L3 nerve root.
Due to profound weakness in his leg, the patient elected for surgical management. Dr. Patel performed a L3-4 endoscopic far lateral discectomy. The Disc was removed and the operating room time was 50mins with 0cc of blood loss via a 7mm incision.
Patient is now 2 weeks post operative and couldn’t be more pleased. He has no pain in his leg or his back. The patient reports he is almost at full strength and uses a cane only when he is out of the house.
The Trigger-Flex Quad is an ideal instrument used for endoscopic stenosis procedures. With Quad bipolar tips, the Trigger-Flex Quad can manage large surface areas of tissue with precision and ease. The Trigger-Flex Quad fits down the elliquence Stenosis endoscope and provides a clear picture to determine anatomic landmarks. If a bleeder ever comes into view, you can utilize the Trigger-Flex Quad to regain visualization by targeting and stopping the bleeder. With tactile feedback and steerable, navigational access, the Trigger-Flex Quad is a necessary tool for providing safe and precise nucleus ablation and spine coagulation.
Another great first case performed at HSS by Dr. Sravisht Iyer! The female patient presented with a right-sided foraminal disc herniation extending medially into the lateral recess with slight cranial migration at the L3,4 lumbar level. Her primary complaint was right-sided radiculopathy. An elliquence clinical staff member conferred with the surgeon and they reviewed the MRI pre-op and mapped out the best trajectory for accessing the pathology with an “outside-in/extraforaminal” approach. After targeting with a 16ga needle, the elliquence sequential dilators and re-useable trephine system were used to make a foraminotomy. The endoscope was placed and the pathology was visualized and removed with no need for augmentation of the foraminotomy. The elliquence “Triggerflex” radiofrequency device was then used to regularize the friable tissue and achieve hemostasis. The physician completed two cases on this day utilizing the elliquence transforaminal endoscopic system and both patients did very well post-op and exceeded the surgeons expectations.
elliquence®, LLC, can equip you with simple, smart, and comprehensive Endoscopic Spine Systems. Our endoscopic systems offer clinicians the full ability to perform endoscopic procedures with approaches for Transforaminal, Interlaminar, Rhizotomy, and Spinal Stenosis. Our scopes are compatible will all major endoscopic towers, and are available in various lengths and sizes that provide crystal clear optical definitions allowing for ultra-precision and durability. Our endoscopic spine systems combined with the Surgi-Max Ultra and the Trigger-Flex Bipolar create the ultimate pairing for you to treat your patients with residual back pain.
Video of and MIS and Endoscopic Lab proctored at elliquence HQ by Dr. Jose Gabriel Rugeles
Close to a year ago, Dr. Sophie d’Herbemont attended one of our elliquence educational workshops focused on MIS procedures. With the knowledge she learned from Dr. Nicolas Prada, she continues to grant her patients with the pain relief they need.
This patient was a 44-year-old female, with axial pain lasting more than six weeks, and facetary pain of right predominance. Working in a restaurant, the patient would lift heavy material on a daily basis, putting wear and tear on her body. She needed a solution to help relieve her back and leg pain, and Dr. Sophie had the solution. Dr. Sophie used Disc-FX and Trigger-Flex Dart on levels L4-5 and L5-S1 to treat contained disc herniations. When the patient awakened from the procedure, she was pain free!
It is a true pleasure to see her using the skills and knowledge she had gained to provide her patients with the pain relief they were looking for.
I have used many endoscopic systems over the years, but I find the elliquence spine endoscopy systems to be very reliable and durable, and I always get a great image during my procedures.
elliquence keeps the economics very easy for the hospital so there are no large capital purchases that are required, and the hospital’s existing video towers are perfectly compatible with their scopes.
-Jorge Isaza, M.D. from Spine Specialists of Louisiana
The Surgi-Max Drill is an ideal instrument for removing bone and permitting access to the targeted pathology in endoscopic spine surgery. With precision and smooth operation of the motor and angled handpiece, along with various burr sizes and shapes, the Surgi-Max Drill is another tool you can utilize in your endoscopic procedures to provide your patients with safe and quality care.
“I have been motivated to learn spine endoscopy for quite some time, and elliquence has allowed me the opportunity to visit them to participate in a cadaver lab, and they subsequently assisted in the process of gaining approval at our Hospital, which is not an insignificant accomplishment. Additionally, elliquence allowed our entire department to visit for a lab held just for us, so that our team became very familiar with spine endoscopy and the different approaches.” – Sanjeev Kumar, M.D.
Trigger-Flex® Bipolar System has been utilized globally in minimally invasive spine and other orthopedic procedures for the navigational, targeted application, and precise tissue effects it affords. Compatible with all working channel scopes, the Trigger-Flex® Bipolar System is a compliment to all procedures for hemostasis, shrinkage, or ablative effects in soft tissue. Several shafts and handle configurations are available to accommodate surgeon preference or surgical requirements.
Presented by Jin-Sung Luke Kim, M.D., Ph.D. and Stefan Hellinger, M.D.
Date: Friday, December 18th, 2020
Time: 9:00 AM EST
Language: English and Spanish
“One of the most useful tools ergonomically, is the table mounted holding arm. I find that its articulation and ease of use for myself and my OR staff allows unprecedented mobility which allows me to keep the working canula in place while I focus on scope rotation and instrumentation placement at the pathology.
There are no internal cables that can stretch or require adjustment like other designs and setup is simple and reliable with a delron clamp that is gentle on the working channel of the scope yet rigid enough to keep things in place. Elliquence has also allowed me to customize my instrument sets so I have a uniform selection of favorite instruments which means the sets are optimized and consistent in their format which is especially useful when I have back to back cases.
This streamlines my cases, particularly when I am performing an endo T-LIF where instrumentation from multiple vendors can quickly add up. The elliquence up-biting flexible tip grasper is also one of my favorites and it carries a universal role for reaching multiple pathologies while effectively holding on to diseased tissue for removal.”
The Surgi-Max Ultra has enhanced waveforms to be cleaner with less distortion. This allows ALL of the elliquence RF probes to work much more efficiently on various tissue (disc nucleus, disc annulus, connective tissue, ligament, etc.) With older generators, the tissue tended to stick to the probe tip, requiring occasional cleaning. With the Surgi-Max Ultra, the tissue does not stick, even with increased power settings.