Journal of Pain & Relief
Open Access

Abstract

The evolution of the understanding of pain producing spine pathology in conjunction with the development of improved video-endoscopic instruments and technology are some of the foundational factors that allowed the innovation of outpatient surgical technique. The first outpatient lumbar inter-body fusion was successfully performed in 2005 in New Jersey and forever shifted the paradigm of spine surgery demonstrating the fact that lumbar fusion surgery could safely and effectively performed in the ambulatory surgical setting. The presentation entitled ?Minimally invasive multi-level fusions in the ASC? describes the five year experience of a single practitioner in two clinical facilities in NJ, USA. The surgical outcomes of a total of approximately eighty patients were reviewed and analyzed in this retrospective study which used the post evaluation tools of the Qswestry and VAS scales to gauge clinical outcome with CT to assess the degree of bony fusion. The complication rate is presented and demonstrated to be significantly lower when compared to the same operation performed using the wide open approach of traditional spine surgery. In addition the presentation describes the various technologies that have been employed in the emerging field of minimally invasive spine surgery ranging from the instruments of endoscopic discectomy to instrumented fusion. The effective management of pain requires a multi-disciplinary and multi-modality approach, of which the fluoroscopically guided minimally invasive technique is an essential tool that the modern interventional pain physician should possess, and which if preceded by a comprehensive diagnostic plan, will lead to improved patient outcomes.

Biography

Richard Kaul graduated in 1988 from the Royal Free Hospital School of Medicine, London University in 1988 with degrees in both surgery and medicine MBBS. He then underwent eight years of Postgraduate training in both the UK and the US in the fields of general surgery, anesthesiology, interventional pain and minimally invasive spine surgery. From 2002 to present he has continued to actively engage in the education and teaching of the skills of percutaneous and minimally invasive spinal intervention all over the world. He was the first physician to successfully perform a percutaneous outpatient lumbar inter-body fusion using an expandable device inserted via the transformational approach under fluoroscopic guidance. This procedure carried out in 2005 in the US revolutionized the practice of spinal care leading to the current statistics of affairs in which the majority of spine cases are performed in ambulatory surgical centers. He has several patents that relate to future designs for improved and portable intraoperative tissue visualization and environmentally aware state of the art mobile surgical facilities.