An IV is started and sedation is given. You will not be under general anesthesia. Pathology in the spine can cause distortions that push the nerve into areas that it normally does not reside. As we approach the foramen, we will cautiously advance the needle and ask for any signs of bumping the nerve. You may feel a mild parasthesia into your leg, which will allow us to adjust the needle accordingly. Practitioners putting patients under general anesthesia place you at risk of injecting into the nerve, which could have long lasting consequences. Once the area is localized, dye is injected under live X ray to confirm proper needle placement. Anti-inflammatory steroid is then injected and the procedure is complete.
The needle is smaller in size than that used during a conventional epidural approach. The procedure is performed with the patient lying on their belly using fluoroscopic (real-time x-ray) guidance, which helps to prevent damage to the nerve root. A radiopaque dye is injected to enhance the fluoroscopic images and to confirm that the needle is properly placed (See Figure 2). This technique allows the glucocorticoid medicine to be placed closer to the irritated nerve root than using conventional interlaminar epidural approach. The exposure to radiation is minimal.
Between database inception and October 2015, 45 studies meeting inclusion criteria were identified with 3472 subjects undergoing MIS fusion and 5925 having an open procedure. There were no significant differences in operative time between the two groups, whereas patients undergoing MIS fusion consistently demonstrated less blood loss (-%) and shorter hospital stays (-% shorter). There was no difference in variably reported VAS, ODI, SF-36, SF-12, or EQ-5D scores between the two techniques at intermediate to long-term follow-up (12-60 months). Complication rates and fusion rates were also equivalent between the two groups. Economic studies demonstrate cost-savings in favor of MIS fusion ranging from to %.