Keano,
I would be interested to learn how PLLD helps annular tear issues. Does it seal the tears?
Mark,
I guess I view minimal invasive spine surgery (for discs) as needing to be minimal on two fronts:
1. minimal flesh wound not larger than endoscopic, and
2. minimal puncture of disc ie one that is likely to heal and not initiate new or accelerate degeneration.
If an endoscope is used but surgeon creates a box incision through annulus to remove some nucleus material, I would regard the surgery as major invasive as far as the disc is concerned, with increased chance of fusion or ADR required in future.
The Dr Hoogland ‘abrasion’ includes.... “a percutaneous transforaminal approach to the posterior segment of the involved disc was performed using special reamers up to 7.5 mm” 7.5mm sounds like a large opening needing to be permanently sealed somehow.
This is study outcome of 5mm animal puncture model…
Nerve fiber ingrowth into scar tissue formed follo... [Spine (Phila Pa 1976). 2006] - PubMed result
Even fine needle holes through annulus have been identified as posing a risk of initiating disc degeneration.
SMALL AND LARGE GAUGE NEEDLE PUNCTURE AFFECTS INTERVERTEBRAL DISC MECHANICS AND BIOLOGY IN AN ORGAN CULTURE MODEL -- Costi et al. 91-B (2): 351 -- The Journal of Bone and Joint Surgery (Proceedings)
2009 ISSLS Prize Winner: Does Discography Cause Accelerated... : Spine
Following paper is very interesting as it reports on short term disc outcomes where unintended discs were punctured by mistake during surgery.
Does Incorrect Level Needle Localization During Anterior Cer... : Spine
I think maybe the back surgery industry keeps silent on using supplements for disc regeneration (even if they work), and on the importance of maintaining annular integrity, because it depends on a steady, preferably increasing, flow of new patients thru the door. It is critical comment, that would be good to be disproved.