Transcript Laser Back Surgery Slideshow

Endoscopic Laser Lumbar
Disc Decompression.
Michael W. Meriwether, M.D., P.A.
Neurosurgeon, Board Certified
Sarasota, Florida
USA
Michael W. Meriwether M.D., P.A.
Undergraduate
Duke University, 1971
Medical Graduate
University of North Carolina, 1975
Neurosurgery Resident
Bethesda Naval Hospital, 1980
Associate Professor
USF Medical School Tampa, FL
USUHS Medical School, Bethesda, MD
Chief of Staff Doctor’s Hospital, Sarasota, FL
Patient Indications
History of Leg Pain Greater
than Back Pain
Neurological Symptoms in
a Sciatic Distribution
Failure to Respond to
Conservative Care
MRI Scan Demonstrating
Focal Disc Protrusion
Percutaneous Technique
Minimally Invasive Percutaneous Discectomy
Outpatient Surgery
Posterior-lateral approach
Local /IV Sedation
Technique
Insertion of trocar
Cannula placement
Trephine annulotomy
Disc removal
Criteria For Success
Relief of Sciatica
Off Narcotic Medications
Return to Work/Business Functions
Conservative Care
Average Time From Symptoms Until
the LASE Procedure
12 Months average
Average Length of Time For Conservative Care
9.4 Months average
Modified Magill Pain Scale
1 - No Pain
2 - Occasional Pain
3 - Mild Pain
4 - Moderate Pain
5 - Severe Pain
McNab Criteria
1 - Excellent
2 - Good
3 - Fair (Group placed in failure category)
4 - Poor (Failures)
Levels
L2-3
7.1%
L5-S1
36%
L3-4
21.5%
L4-5 35%
Pre-operative Pain
50
0
BACK
.
LEG
LEG
BACK
Post-operative Pain
100
50
0
1
2
3
LEG PAIN
4
BACK PAIN
5
Pre-Op and Post-Op Charts
80
60
40
20
0
1
2
3
Post-Op
4
Pre-Op
5
Follow Up
Office Visit
Mailing Questionnaire
Subsequent MRI
Average Length of Time for Post Operative Follow-Up:
66 months average
Success Using Endoscopy
Technique (McNab 1 & 2)
Follow-up @ 66 months
778
800
620
544
600
400
200
0
Total Patients
Total Level
Success
Success Rate
522 out of 620 = 84.20%
Failures
98/620 - 32 surgeries
15.80 % - 5.16% of the total
McNab 3 & 4 - 14 pts L-MCD
13 pts BAK-L/RTC Fusion
3 pts DLL
5 pts SCS Implantation
Additional Information
No Infections Occurred
No Nerve Root Injuries
Occasional transient Causalgia Syndrome that
resolves to therapy / medications