Access for SED is like most endo discectomies... it is through the soft tissue and follows the path of the discogram needle. They use expanding canulas... increasing diameter tubes to convert the needle stick into an opening large enough to accomodate the scope.
Even though they use the needle path for the scope, the may still have to remove a small amount of bone to clear the scope. THIS IS WHERE ALL MISS PROCEDURES ARE NOT CREATED EQUAL. I have several clients who thought they were getting MISS procedures that would preserve their later ADR option, but the surgeon removed too much bone, basically removing a facet, and destabilized the system so that ADR was no longer an option.
You must discuss this with the surgeon in advance and be certain that he understands and is experienced enought not to just do it the easy way... but to get it done the right way. In one of these cases, it was a complete surprise when the patient discovered 6 months later that a facet had been removed. So much for MISS for him.
Mark
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