If anyone requires and information with regards to Mr Knight etc please don not heistate to contact me. I had a procedure done with him in Oct 2006. Any questions or advice...
Regards
Lisa Sinden
More information about your treatment from Martin Knight
Hi,
I'm sorry to hear you had a bad experience with your surgery from Martin Knight.
What procedure did you have?
I'm going to see Martin Knight On Monday so I'm very interested to hear about the drawbacks of his treatment- many people seem to have a success story but these are the ones you tend to see posted on the discussion boards.
Did the pain ever reduce or do you still have it? What kind of pain? Were you warned before the operation that this was possible outcome?
i would advise to keep away from who you ask about, i am virtually crippled after surgery in 1996, if you do go and see him, think about it and take advise from someone else first before any procedure,
I will try to be as simple as I can, generally speaking.
Every surgery has risks, even when you are pulling your teeth with advanced oral surgeon.
Traditional spine surgery has overall long-term success from 50-70% and intraoperative complications rate up to 10%.
MISS (that respected Martin Knight is performing) has overall long-term success rate from 80-90%, and intraoperative complications happen in 1% of cases.
What I want to say? Me, you, your grandmother or your cousin can be in this 1% of Martin Knight's complications cases. Nobody can predict that and not everything is the surgeon's hands.
The fact it - YOU ALL HAVE BETTER CHANCES OF SUCCESS AND LIFE WITHOUT PROBLEMS IF YOU CHOOSE MINIMALLY-INVASIVE SPINE SURGERY. This is the fact proven in scientific studies and worldwide research in past 20 years.
The fact it - YOU ALL HAVE BETTER CHANCES OF SUCCESS AND LIFE WITHOUT PROBLEMS IF YOU CHOOSE MINIMALLY-INVASIVE SPINE SURGERY. This is the fact proven in scientific studies and worldwide research in past 20 years.
And your source is?
Thanks,
Myarka
Is it not the case that an assessment of statistics against one man performing one method of surgery in Bristol against what i have been told is the 2nd most common spinal procedure (open surgery) in the UK of very shallow use? albeit very interesting.
And your source is?
Thanks,
Myarka
If you write to MK he will send you a huge pile of independent documents and statistics bearing out that fact, and as a part of his consultation he goes through every possible treatment and operation and gives the facts and figures of the success rates and what can be expected. Funny cos your question was exactly what my nhs surgeon asked me, when I asked him for proof of his figures he couldn't provide any facts to back up his low rate of success or the 53% chance that I may end up in a wheel chair and he didn't really seem to care either.
It's all about research really and a persons choice.
are you saying that 53% of people who have open surgery for discectomies end up in a wheel chair?!:confused:
are you saying that 53% of people who have open surgery for discectomies end up in a wheel chair?!:confused:
Not exactly, those were the figures I was given for my situation and there will be several reasons why they decided on that rather high figure, age, extent of the disc protrusion/herniation, nearness to the spinal nerves etc etc.
Bad luck for me but meant I wasn't going to risk it whilst I can still walk a little, hence looking for other alternatives.Just ask your surgeon lots of questions, everyone is different and needs to be treated asuch.
But, then again we all know there is a risk in any operation.
Do you know i can not believe the amount of people i already know or have been aquainted with who have this problem. Just today i bumped into a former colleague who had been given a 50/50 on whether he would walk again post discectomy.
Prior to my operation i was given the usual stats of 10 % chance of minor complication and 90% success rate i did enquire with my surgeon and he did say that those were the stats for someone of my age (32 years male). However another friend of mine of same age having been given the same stats had a serious relapsed and a second discectomy (5 years gap).
I too believe that information should not just be accepted but honed using as much query and questioning as possible.
I so so hope you get the type of surgery you need.
Might be worth a plane ticket to america and an E1 11!
And your source is?
Thanks,
Myarka
Hiya Myarka.
I don't know which studies Keano was specifically referring to
when he stated (((YOU ALL HAVE BETTER CHANCES OF
SUCCESS AND LIFE WITHOUT PROBLEMS IF YOU CHOOSE MINIMALLY-INVASIVE SPINE SURGERY)) The fact it - This is
the fact proven in scientific studies and worldwide research in past
20 years.)) and I am not speaking for Keano or anyone else for
that matter, nor am I sourcing his words, but I 'genuinely hope'
that I can help you and other members with a better understanding
of Keano’s basic 'and I believe' correct assertion.
The assertion is, that 'the less' a Spine Surgeon damages skin,
tissue, nerves, ligaments and cartilage during their approach to
the patients problem area 'the better'. This is particularly true of
muscle and vertebral damage, as damage here can cause
significant and lasting weaknesses and spinal imbalance, even
after the goals of an operation has been 'successfully' achieved.
As a general point, I feel sure that we all would agree, that
avoidance of this type of collateral damage and complications,
must be a good thing for patients!
To help with this understanding, I have posted (below) just a
small amount of the available information, which independently
confirms the shear volume of the 'consensus' of the medical
community, as to the 'necessity, validity and increasing
acceptance' of MISS procedures and principles by main
stream medical bodies around the world. In fact, the 'huge
increase' in MISS information has even staggered me!
There has been a 'massive explosion' of available concurring
medical information over the last 3 years!!
I must however offer a word of caution, not all stated MISS
procedures are actually MISS procedures at all. Minimal
clearly means, the least of, the smallest amount of or the
smallest proportion of, depending on the dictionary's you use,
so if a procedure can be improved by reducing the amount of
cutting and stripping involved in it, then it is not 'by definition'
minimal. This confusion is allowed because the MISS tag is
not protected by patent laws, so anything 'less invasive' than
traditional 'open back' spinal surgery can legally be called
MISS, and frequently is being described as MISS, even
when these procedures are often not strictly or
sometimes not even remotely minimal.
However, I strongly believe, that this 'does not mean'
that these procedures are worthless, if a procedure tries
to maintain a patients mobility without creating serious side
effects, it can still be considered very beneficial and
appropriate for the patient. I think that these procedures are
best described as Less Invasive Spine Surgery or 'LISS' or
'MAS' rather than MISS, thus avoiding confusing potential
patients. Her are some examples!
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.spinalsurgerynews.com/articles.php?key1=8& "> http://www.spinalsurgerynews.com/articles.php?key1=8&
key2=1
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.express.co.uk/posts/view/227718 "> http://www.express.co.uk/posts/view/227718
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" https://www.ianjharding.com/Treatments.html "> https://www.ianjharding.com/Treatments.html
This link below shows just how far 'some organisations'
and 'Surgeons' are prepared to go, to associate themselves
with the minimally invasive 'MISS brand' and just how
careful the potential patients must be in selecting a treatment
route. In the video in the link below, the procedure is
advertised as Minimally Invasive Lumber Fusion, but as
you can clearly see from the images, the patient's back is
clearly ‘open’ and ‘kept open’ by the use of expanding
retractors, which stretch, pull and compress the surrounding
body parts, which in itself, could cause post operative
complications.
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href="
">
feature=related
In order to be even handed, I have included 2 links to
sites that 'reasonably dispute' the superiority of MISS
over conventional ‘open back’ procedures, these are
reasoned findings, but what is interesting to note, is that
even these reports fail to prove that MISS spine surgery
is significantly less effective than open back surgery nor
that MISS is in any way, more dangerous.
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076584 "> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076584
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.spine-health.com/treatment/back-surgery "> http://www.spine-health.com/treatment/back-surgery
/minimally-invasive-anterior- approach-spine-surgery
The variety of links below, not only show the increase of
MISS procedures and clinics, including units at some of the
worlds most renowned hospitals like Johns Hopkins and
New York Presbyterian, but also of the many and varied
legitimate procedural differences within the MISS family.
Some of these links are gleaned from medical and
academic sources, others from practicing clinics, others
from press releases and medical web sites and so on. As
such, these are not my words, nor those of Keano, but those
of respected and experienced Surgeons from around the world
and which can be found on peer and patient re-viewable
resources.
Their conclusions appear to be, that 'future investment and
training' in the MISS group of procedures, is a desirable and
an evolutionary course of action for every spinal unit or clinic,
be they NHS or private, because any procedure that reduces
'procedural damage' caused by 'working area access' will
offer the best possible and most consistent post operative
clinical outcomes for patients with chronic spinal nerve
compressions. I think this and the overwhelming evidence
below is why Keano reached his emphatic statement!
Sadly, you will see that very few of these dynamic MISS, MAS
and LISS centres are located in Britain, this is why the focus of
MISS treatment supporters threads on this forum are
concentrated and polarized on the 2 or 3 UK clinics that offer
this cutting edge treatment!
However, I believe that this 'increasing awareness' of the
medical community, about MISS principles, is on an
inexorable advance towards every day use of minimally
invasive principles and techniques which will take root in
Britain, but again sadly, probably not in my life time.
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pubmed/21107934 "> http://www.ncbi.nlm.nih.gov/pubmed/21107934
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.smiss.org/minimally-invasive-faq.php "> http://www.smiss.org/minimally-invasive-faq.php
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ismissturkey.org "> http://www.ismissturkey.org
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://neurosurgery.stanford.edu/patient_care/neurospine.html "> http://neurosurgery.stanford.edu/patient_care/neurospine.html
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.aaos.org/news/aaosnow/sep09/clinical12.asp "> http://www.aaos.org/news/aaosnow/sep09/clinical12.asp
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.spinal-foundation.org/Clinical-Outcome-Research "> http://www.spinal-foundation.org/Clinical-Outcome-Research
/ELF-Clinical-Outcomes
[DLMURL="http://newsatjama.jama.com/category/journalologypeer-"] http://newsatjama.jama.com/category/journalologypeer- [/DLMURL]
reviewauthorship
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.hopkinsmedicine.org/neurology_neurosurgery/ "> http://www.hopkinsmedicine.org/neurology_neurosurgery/
specialty_areas/spine/conditions/minimally_invasive_spine_
surgery.html
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://nyp.org/enews/minimally-invasive-back-surgery.html "> http://nyp.org/enews/minimally-invasive-back-surgery.html
[DLMURL="http://my.clevelandclinic.org/services/minimally_invasive_"] http://my.clevelandclinic.org/services/minimally_invasive_ [/DLMURL]
spine_surgery/sp_overview.aspx
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.jbjs.org.uk/media/31938/focuson_lumbar.pdf "> http://www.jbjs.org.uk/media/31938/focuson_lumbar.pdf
[DLMURL="http://www.spineuniverse.com/treatments/surgery/minimally"] http://www.spineuniverse.com/treatments/surgery/minimally [/DLMURL]
-invasive-spine-surgery-information
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.dailymail.co.uk/health/article-1090489/I- "> http://www.dailymail.co.uk/health/article-1090489/I-
surgery-spine--awake-time.html
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.bidmc.org/CentersandDepartments/ "> http://www.bidmc.org/CentersandDepartments/
Departments/SpineCenter/HotTopics/MinimallyInvasive
EndoscopicSurgery.aspx
[DLMURL="http://www.sages.org/publication/id/PI03"] http://www.sages.org/publication/id/PI03 [/DLMURL]
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.jbjs.org/article.aspx?Volume=88&page=226 "> http://www.jbjs.org/article.aspx?Volume=88&page=226
[DLMURL="http://www.cxvascular.com/sn-features/spinal-news---"] http://www.cxvascular.com/sn-features/spinal-news--- [/DLMURL]
features/is-minimally-invasive-spinal-surgery-the-future
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.hindawi.com/journals/ijso/2011/598148 "> http://www.hindawi.com/journals/ijso/2011/598148
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.beckersorthopedicandspine.com/spine/item/ "> http://www.beckersorthopedicandspine.com/spine/item/
9710-endoscopic-spine-surgery-6-things-to-know-
about-the-present-and-future
[DLMURL="http://www.touchbriefings.com/pdf/2886/iprenburg1.pdf"] http://www.touchbriefings.com/pdf/2886/iprenburg1.pdf [/DLMURL]
[DLMURL="http://www.touchbriefings.com/pdf/3224/godschalx.pdf"] http://www.touchbriefings.com/pdf/3224/godschalx.pdf [/DLMURL]
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076584 "> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076584
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095800 "> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095800
[DLMURL="http://www.isass.org/pdf/sas11/3-Thursday/Plenary-"] http://www.isass.org/pdf/sas11/3-Thursday/Plenary- [/DLMURL]
Degenerative-Scoliosis-Where-to-End-the-Fusion/527.pdf
[DLMURL="http://www.wsc.ae/pagecontents.aspx?pageid=10"] http://www.wsc.ae/pagecontents.aspx?pageid=10 [/DLMURL]
[DLMURL="http://www.totalhealth.co.uk/clinical-experts/mr-khai-"] http://www.totalhealth.co.uk/clinical-experts/mr-khai- [/DLMURL]
lam/minimal-access-spinal-surgery
To discover just how far behind 'technological advances'
British diagnostics services are, take a look at these 2 links,
they show where we should be!
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.uprightmri.co.uk "> http://www.uprightmri.co.uk
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href="
">
Over the last 4 years, like Cascara, I have received 5-6
clinical trial reports regarding the clinical outcomes of MISS
procedures, I have stored them away, but I am unable to get
at them at the moment. If I get better soon, I will find them
and post these links as well.
I hope I have gone some way to answering your question
Myarka,
Best wishes and kind regards
SPINELF
Error
I simply can not believe the amount of people i have met (not via the internet) now who have experienced this ailment, including friends i have known for years who would rather never mention their experience post surgery even to their close friends. Since i have under gone open back surgery for my L5/S1 i have virtually unlocked a subculture wherever and whenever i mention what i have been through.
The experiences always seem to be the same that the wait on the NHS is ridiculous and in the event of surgery whether private or on the NHS it is always open surgery. Spinelf and other posters are right that in the UK we do not get the cutting edge treatment that is available elsewhere in the world. This is as much a political issue as it is a health care issue.
Despite the ill timing (in view of current events) and the fact that i personally have undergone open back surgery (seemingly with successful results and minimal damage) I would be more than intrigued to see if any members of this group (particularly in view of the good research of some members) would be interested in lobbying central government about this issue.
I would love to know some thoughts on this from people who may have the time and inclination in particular from posters with a wealth of input and sources such as keanu and spinelf.
I work across various areas of law including employment and unfair dismissal as a result of prolonged absence from work and i am constantly bombarded with benign statistics about absences from work as a result of back pain or back ailments. My surgeon also has informed me that he believes that discectomies are probably the 2nd most frequent spinal procedure in the UK. Isn't it about time this condition was met with a quicker willingness to provide a proper MRI at the outset with the best and least damaging surgery available to get the hundreds of people back to work quickly?!
How excellent it could be try and take the input and research of members of this forum directly to central govt.....or maybe i'm suffering from a eutopian episode.
who says you have to be in oil to lobby government?
Good research SPINELF.
I didn't want to respond to Myarka because answers are so obvious and she already knew them...
If you are interested in benefits and the advantages of minimally-invasive spine surgery (from technical and scientific point of view) - do the research, this 5 links are more than enough.
[url]American Journal of Neuroradiology[/url]
[url]An Error Occurred Setting Your User Cookie[/url]
[url]ScienceDirect - Home[/url]
[url]National Center for Biotechnology Information[/url]
Regards.
I work across various areas of law including employment and unfair dismissal as a result of prolonged absence from work and i am constantly bombarded with benign statistics about absences from work as a result of back pain or back ailments. My surgeon also has informed me that he believes that discectomies are probably the 2nd most frequent spinal procedure in the UK. Isn't it about time this condition was met with a quicker willingness to provide a proper MRI at the outset with the best and least damaging surgery available to get the hundreds of people back to work quickly?!
How excellent it could be try and take the input and research of members of this forum directly to central govt.....or maybe i'm suffering from a eutopian episode.
who says you have to be in oil to lobby government?
I have been looking at this very thing. It would be great to put all this knowledge to good 🙂
Me too Cassie, I have given this ‘lobbying matter’ a lot of thought over the years, and have come to the conclusion that ‘only’ a multi pronged approached will succeed.
Something along these lines:
1)
Get the support of a sympathetic MP, perhaps someone who has personally experienced spinal problems, or someone who has family members who are or have experienced these problems, and is prepared to really mix it up in parliament and to raise support amongst other MP’s ahead of an E-petition campaign!
2)
Get the support of a sympathetic and brave, newspaper or media ‘medical issues’ Editor, who could raise the awareness of all of UK’s spinal pain sufferers and their families by posting regular editorials, features and providing more comprehensive research than any of us can muster, and will be able to support the build up to the E-petition launch!
3)
Set up an E-petition with a ‘carefully and strongly worded demand’ for the release of information (that we know they don’t have) and for immediate improvements in NHS spinal diagnostics and treatment services, funding for 'out of area' treatment as of right, and even 'out of country' procurement and funding for the most cutting edge minimally invasive and spine surgeons if required, who can provide the best outcome results for their patients.
4)
Get support from a ‘pro bono’ or ‘no win, no fee’ legal team, to support challenges against any obstruction, non-compliance or down right fibbing as ‘the guilty get twitchy’ as the public get to see what exactly is going on in the world of UK spinal services.
I realise, that this may seem a bit ‘alarmist’ to many, but I truly believe, that when the power and finances of the corporate and medical ‘legal eagles’ and ‘PR people’ swing into action, to protect this ‘very lucrative’ health market, I believe that the ‘oncoming backlash’ will be a thing to marvel!
SPINELF
Me too Cassie, I have given this ‘lobbying matter’ a lot of thought over the years, and have come to the conclusion that ‘only’ a multi pronged approached will succeed.
Something along these lines:1)
Get the support of a sympathetic MP, perhaps someone who has personally experienced spinal problems, or someone who has family members who are or have experienced these problems, and is prepared to really mix it up in parliament and to raise support amongst other MP’s ahead of an E-petition campaign!2)
Get the support of a sympathetic and brave, newspaper or media ‘medical issues’ Editor, who could raise the awareness of all of UK’s spinal pain sufferers and their families by posting regular editorials, features and providing more comprehensive research than any of us can muster, and will be able to support the build up to the E-petition launch!3)
Set up an E-petition with a ‘carefully and strongly worded demand’ for the release of information (that we know they don’t have) and for immediate improvements in NHS spinal diagnostics and treatment services, funding for 'out of area' treatment as of right, and even 'out of country' procurement and funding for the most cutting edge minimally invasive and spine surgeons if required, who can provide the best outcome results for their patients.4)
Get support from a ‘pro bono’ or ‘no win, no fee’ legal team, to support challenges against any obstruction, non-compliance or down right fibbing as ‘the guilty get twitchy’ as the public get to see what exactly is going on in the world of UK spinal services.I realise, that this may seem a bit ‘alarmist’ to many, but I truly believe, that when the power and finances of the corporate and medical ‘legal eagles’ and ‘PR people’ swing into action, to protect this ‘very lucrative’ health market, I believe that the ‘oncoming backlash’ will be a thing to marvel!
SPINELF
Thank you for your tips!
Allan
Hi Everyone, newbie here 🙂
Why am I here: My wife has just suffered multiple prolapsed discs causing a sciatic infection whilst we were away on holiday in Austria - luckily! As she had a CT scan the day after seeing the local GP over there, then she has received three CT guided epidurals in the last fortnight. (thinngs seem to move a bit quicker over there!)
The surgeons are suggesting she will need surgery to remove the largest disc bulge which seems to be about 2/3 out on the CT image.
So this is why I am here - trawling the internet, doing my research about the procedures and what the future holds...
Why I am on this thread....
We live in Manchester, UK. My wife will be flying back sometime next week. I have been reading a number of threads on here about Microdiscectomy, MISS and Endoscopic laser surgery(are these last 2 the same?).
Is it really worth the £10000 to have the minimally invasive technique? I have found a review paper from 2010 (the study accepted research up until May 2008) from the 'European Spine Journal' which concludes that there is no significant difference in the outcomes of open back versus 'Transoraminal Endoscopic Surgery' (this is MISS, right?)
Thanks for all the help I have already received from reading through previous posts, and any you can offer in the future 🙂
Hi Everyone, newbie here 🙂
Is it really worth the £10000 to have the minimally invasive technique? I have found a review paper from 2010 (the study accepted research up until May 2008) from the 'European Spine Journal' which concludes that there is no significant difference in the outcomes of open back versus 'Transoraminal Endoscopic Surgery' (this is MISS, right?)
Hello and welcome Treebeard!
I am very sorry to read about your wife's problems!
I am busy at the moment with family issues, but will get back to you tomorow with my thoughts regarding your questions and issue about the study, I hope thats OK ?
Best wishes 
SPINELF
Hi Everyone, newbie here 🙂
Why am I here: My wife has just suffered multiple prolapsed discs causing a sciatic infection whilst we were away on holiday in Austria - luckily! As she had a CT scan the day after seeing the local GP over there, then she has received three CT guided epidurals in the last fortnight. (thinngs seem to move a bit quicker over there!)
The surgeons are suggesting she will need surgery to remove the largest disc bulge which seems to be about 2/3 out on the CT image.
So this is why I am here - trawling the internet, doing my research about the procedures and what the future holds...
Why I am on this thread....
We live in Manchester, UK. My wife will be flying back sometime next week. I have been reading a number of threads on here about Microdiscectomy, MISS and Endoscopic laser surgery(are these last 2 the same?).
Is it really worth the £10000 to have the minimally invasive technique? I have found a review paper from 2010 (the study accepted research up until May 2008) from the 'European Spine Journal' which concludes that there is no significant difference in the outcomes of open back versus 'Transoraminal Endoscopic Surgery' (this is MISS, right?)
Thanks for all the help I have already received from reading through previous posts, and any you can offer in the future 🙂
This article was not published by the surgeons, but by the researchers who do not have personal experience with minimally-invasive spine surgery. They are only researching literature publishes by the others.
I think that in case of your wife price of the surgery would be even higher, because she has multiple herniated discs.
And last, my opinion. If you can afford it, I think it is worth the money.
Hi Keano.
The researchers may not have any experience of the procedures, but they don't need any - they are simply looking at a lot of research (every study published in English, German, and Dutch over 25years which met specific criterea) by people who do know alot about the procedures, and then extracting the data from that.
Also what does anyone know about Mr Irfan Malik, who seems to be performing MISS on the NHS at kings college, london...?
And another name thats come up in my research... Mr Lester Wilson of the Royal National Orthopaedic Hospital.
I agree with you, but trust only the surgeons that have performed booth classic spine surgery and minimally-invasive spine surgery. They are the only ones that can judge and give the final word about it. I trust only their literature.
"Mr Malik's key area of expertise lies in keyhole endoscopic spine surgery; which he has pioneered at Kings' College Hospital. At present he is the only surgeon in the UK to offer this procedure."
ha ha ha......
However, Lester Wilson does seem interesting. He is member of ISMISS, roof society for minimally-invasive spinal surgery founded by Parviz Kambin. All Members of ISMISS perform true state of the art spinal surgery.
I agree with you, but trust only the surgeons that have performed booth classic spine surgery and minimally-invasive spine surgery. They are the only ones that can judge and give the final word about it. I trust only their literature.
"Mr Malik's key area of expertise lies in keyhole endoscopic spine surgery; which he has pioneered at Kings' College Hospital. At present he is the only surgeon in the UK to offer this procedure."
ha ha ha......
Forgive me, but I don't see how it matters who did the trials as long as they were properly contolled and monitored - the only consideration is the effectiveness of the two different techniques.
And yes, I did think that was a bit odd, how is he allowed to put that on his website? But still, does anyone have any experience with Mr Malik or an opinion on his abilities?
Just a bit more specific info on my wifes problem...
it is apparently a mass prolapse in L5/S1, radiating into the right leg. She has had tests done on a neurological ward and as yet there is no nerve damage.
Thanks all 🙂
Sorry, I don't know any patient treated by dr. Malik.
Good luck with your wife
Hi Everyone, newbie here 🙂
Is it really worth the £10000 to have the minimally invasive technique? I have found a review paper from 2010 (the study accepted research up until May 2008) from the 'European Spine Journal' which concludes that there is no significant difference in the outcomes of open back versus 'Transoraminal Endoscopic Surgery' (this is MISS, right?) /quote]
Hiya Treebeard!!
My sincerest apologies for the extended delay in replying, My ‘C’ spine problems are playing up and making it difficult to type and too painful to sit at the computer until today.
----------------
In answer to you question!
((is it really worth the £10000 to have the minimally invasive technique?))
I am sorry to report that think the answer has to be both NO and YES.
(No)
I feel it 'is' too expensive, when this and other MISS & MAS treatments should be on the NHS, available locally and ‘free’ at the point of need, this makes it (in my opinion) far too expensive.
As Mr. Knight is the only Surgeon who ‘openly’ promotes and performs Transforaminal, Endoscopic and Laser Spine Surgery on a private & NHS basis, the number of procedures are limited and therefore the free market sets the price, as ‘economy of scale’ and ‘competitive pressures’ do not apply!! So I again say, that it is not worth £10,000!!
Also, the big question for most of us of course, is will our medical insurance cover the cost ‘or’ can we pay privately? Everyone is different, but the financial pressure is the same!!
Either way, it is a lot of money to commit to a complex and risky procedure with no guarantees.
However, I cannot stress enough, the decision you and your lady wife choose, must be made after you both have had time consider all the facts and ramifications of all the available treatment choices for your wife. I sincerely hope you find the right way forward for you all. Best of wishes!
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(Yes)
I have priced several other ‘cutting edge’ MAS procedures from several UK clinics, and they all come in about the £11,000 mark. Some MAS procedures that are carried out by NHS Spinal Surgeons privately look promising, but are still between £7-10k.
There are cheaper spinal procedures around if you dig, but when I looked at the details of these operation’s descriptions, I found that these cheaper procedures are usually misdescribed as MISS and are simply rehashed ‘open procedures’.
Of all the benefits that MISS offers, one stands out for me! The fact that I was ‘awake’ during my decompression operation in 2008, meant that I was able to ‘talk’ to MK and ‘identify’ the nerve strands causing my long standing sciatic pain when MK stimulated them during the operation.
At one point, he stimulated a nerve he thought ‘might’ be causing a lumber problem and might need treating. The pain signal MK ‘induced’ by stimulating the nerve strand, triggered a ‘transferred pain signal’ in my right shoulder, I never, ever had pain in my right shoulder, so MK could confidently leave it alone!!
If that had happened during a conventional open back surgery, the Surgeon would not have had the benefit of my symptomatic input, as I would be ‘unconscious’ under general anaesthetic and he could well have operated on this ‘no symptomatic’ nerve root, just in case, thus causing collateral damage and new symptoms. This something many patients and forum members have complained of.
For me, this feature made my decompression procedure a complete success, with no ‘collateral damage’ so I think that my £11,000 was well spent.
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One of my favourite sayings is ‘do your research people’ so I am genuinely glad to see you are looking for information in peer reviewed papers and study reports! I salute your determination Treebeard and glad to see that you understand the importance of knowledge!
Sadly Treebeard, I have serious issues with the authors of the study you found. <a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pmc/arti...ticle_1155.pdf "> http://www.ncbi.nlm.nih.gov/pmc/arti...ticle_1155.pdf
1)
First of all, this study brings ‘no new evidence’ to the debate, it simply revisits and assesses previously published papers and evidence, and poorly assesses these. Some of these go back 20 + years.
The authors did not revisit the newer and improved procedures nor discuss them with the Spine Surgeons.
(((Abstract) The study design includes a systematic literature review. The literature ‘has not yet’ been systematically reviewed.))
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2)
Please note this study’s ‘crediting’ of Mr. Knight, as a pioneer of Transforaminal Endoscopic MISS procedures.
((To reach the posterior part of the epidural space, the
superior articular process of the facet joint is usually the obstacle. Yeung and Knight used a holmium-YAG (yttrium-aluminium-garnet)—laser for ablation of bony and soft tissue for decompression, enhanced access and to improve intracanal visualisation [30, 64]. Yeung developed the commercially available Yeung Endoscopic Spine System))
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3)
This study ‘states’ that it makes a comparison between the ‘two’ differing procedures, yet goes on to make a conclusion (below) regarding ‘only 1 of them’ TES!!
This is outrageously bad science and totally unbalanced reporting!!
(Conclusion) This systematic review assessed the effectiveness of transforaminal endoscopic surgery. Of the 39 studies included in this review, most studies had major design weaknesses and were considered having a high RoB. Only one randomized controlled trial was identified, but this trial had poor generalizability. No significant differences in pain, overall improvement, patient satisfaction, recurrence rate, complications and re-operations were found between transforaminal endoscopic surgery and open microdiscectomy. Current evidence on the effectiveness of transforaminal endoscopic surgery is poor and does not provide valid information to either support or refute using this type of surgery in patients with symptomatic lumbar disc herniations.
Studies were heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures and the methodological quality of these studies was poor.
-------------------------------
4)
Whilst the study purports to compare Tranforaminal Endoscopic Surgery with Laminectomy & Microdiscectomy, there is very little, if any, reference to any available information about Laminectomy or Microdiscectomy!
I am sorry to have to say Treebeard, that this lack of clinical and statistical evidence for L & M procedures is not surprising to me!
I have tried to find some for 7 years, still trying!!
To this end, I recently contacted 3 British Surgical Colleges and 2 American Board Certified Surgical Colleges, the people responsible for the procedure types and standards!! Only 2 bothered to reply!!
(details available via PM)
I asked them this question:
Q)
My Surgeon did not have any information pamphlets available at the time of my consultation, regarding the safety and effectiveness elements of the procedure
and I am not sure I got it all. Could the relevant department please send me any information about this procedure and these issues?
Answer 1)
We don’t have any information on this procedure.
Answer 2)
You would need to seek the information from your surgeon, we do not have information on the various operations with regard to patients, I am sure if you contact his secretary she will be able to send you the information you are requesting.
This was after 5 of the biggest NHS spinal units in the UK had reported to me, that they also lacked the same safety, efficacy and trial information, for all NHS decompression surgical procedures!!
This means that potential patients have ‘no way’ of being fully and independently informed, before committing to a surgical treatment pathway!!
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5)
Another major concern for me about this study is the extremely poor quality understanding of the issues shown by the authors and the shockingly bad methodology in their conclusions!!
They suggest ‘below’ that the best ‘or’ correct way to improve the TES paper’s evidence, is to carry out a Randomised Control Trial ( RCT). Sounds sensible?
((Only randomized controlled trials that are adequately designed, conducted and reported and that have a low RoB will provide sufficient evidence regarding the effectiveness of transforaminal endoscopic surgery for lumbar disk herniation. High-quality, randomized controlled trials with sufficiently large sample sizes that compare the effectiveness of transforaminal endoscopic surgery with open microdiscectomy for lumbar disc herniations are needed.))
But look closely (highlighted), they suggest that not only must ‘the patient’ not be told (blinded) which procedure they receive, but that the operating Surgeons themselves ‘must also not know’ which procedure they performed on patients ‘nor’ should they check the post op clinical outcome either!!!
A Was the method of randomization adequate? Y N ?
B Was the treatment allocation concealed? Y N ?
C Were the groups similar at baseline regarding the most important prognostic indicators? Y N ?
D Was the patient blinded to the intervention? Y N ?
E Was the ‘care provider’ blinded to the intervention Y N ?
F Was the outcome assessor blinded to the intervention? Y N ?
G Were co-interventions avoided or similar? Y N ?
H Was the compliance acceptable in all groups? Y N ?
I Was the drop out rate described and acceptable? Y N ?
J Was the timing of the outcome assessment in all groups similar? Y N ?
K Did the analysis include an intention to treat analysis? Y N ?
RCTs might be great for ‘drug trials’ but is ridiculous and impossible for spine surgery!!
Of course, even if this was possible, the post–op incision scar will give the game away, up to 4 inches in L&M and less than half an inch for TES.
Also, with the most truly Transforaminal Endoscopic MISS procedures, patients are walking within 30 minutes of returning to your room and home within 18 hours!! Game over, I think!!
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To sum up, I believe that this study is nothing more than a ‘hatchet job’ which is designed to discredit Transforaminal Endoscopic specifically, and MISS in general, by muddying the ‘waters of understanding’ with ‘doggy science’, ‘misdirection’ and ‘slight of hand’
I am very sorry Treebeard, I don’t think it is worth the paper it was written on!!
Best wishes
SPINELF
Hi Spinelf, and wow, thanks for your time with the reply!
If I could discuss this a little further with you with regards your points made...
1) Yes, The paper although published in 2010 only looked at research up until March(?) 2008 so there has possibly been much development in the last three and a half years. However, the studies included should be valid as both techniques will have developed over the 25 years the review considered.
3) The paper only makes a conclusion about TES because that is what the paper is about "Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature". In the abstract it states "The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations" So the only conclusions to be made are whether there are any benefits to TES.
4) Again, the paper is not about L&M procedures, it is reviewing all available suitable literature on those... there may be some interesting stuff in the references though...
The randomized controlled trial included in the paper ([url]Full-endoscopic interlaminar and trans... [Spine (Phila Pa 1976). 2008] - PubMed - NCBI[/url]) "Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study." concludes... "The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, lumbar disc herniations outside and inside the spinal canal can be sufficiently removed using the full-endoscopic technique, when taking the appropriate criteria into account. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures."
I must confess I have not read this paper, just the abstract. It looks interesting though as the results blurb states..."After surgery 82% of the patients no longer had leg pain, and 14% had occasional pain. The clinical results were the same in both groups. The recurrence rate was 6.2% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: back pain, rehabilitation, complications, and traumatization."
5) I undertand that for it to be doubleblinded it is only the care provider/assessor and the patient who do not know the treatment - the surgeon would just perform the procedure (possibly without knowing the identity of the patient). Although yes, it would be quite obvious by the size of the scar! Unless the TES patients received a superficial cut as part of the operation (not sure about that ethically!) but even then the incisions are in different places aren't they?
I have to say, I don't think the paper is a "hatchet job’ which is designed to discredit Transforaminal Endoscopic". It seems quite robust to me. The problem we have is that until any of the MISS procedures can show a clear and definite improvement in results over that of the conventional techniques, there will be little or no new investment by the public authorities... why should they?
I must make myself clear - I don't want to sound like an advocator of Open back techniques! I am just trying to find out the truth about what could be a very hard decision for us. I believe from the little research I have done that MISS is at least as good as microdiscectomy, but also with some benefits (conscious in surgery, less recovery time, less scar tissue etc.). If only MISS was more frequently used then I'm sure the technique would improve further and show real benefits over the conventional techniques.
Thanks again for your time Spinelf (especially considering your current pain), I really appreciate your help.
🙂
Hiya Treebeard.
Thanks for the repIy, I have downloaded the link info and will reveiw it tommorow, as I am getting tired at the moment.
I will get back asap.
Best wishes
:)SPINELF
4) Again, the paper is not about L&M procedures, it is reviewing all available suitable literature on those... there may be some interesting stuff in the references though...
The randomized controlled trial included in the paper ([url]Full-endoscopic interlaminar and trans... [Spine (Phila Pa 1976). 2008] - PubMed - NCBI[/url]) "Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study." concludes... "The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, lumbar disc herniations outside and inside the spinal canal can be sufficiently removed using the full-endoscopic technique, when taking the appropriate criteria into account. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures."
I must confess I have not read this paper, just the abstract. It looks interesting though as the results blurb states..."After surgery 82% of the patients no longer had leg pain, and 14% had occasional pain. The clinical results were the same in both groups. The recurrence rate was 6.2% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: back pain, rehabilitation, complications, and traumatization."
This is great article. I have a full version, I must find it on my PC.
...wrote by real MISS spine surgeon, world expert in field of endoscopic spine surgery and innovator in field of interlaminar and extra-foraminal approach to treat spinal pathologies, dr. Ruetten.
Hiya Treebeard
I’m back!
If you don’t mind Treebeard, I would like to answer points in your last paragraph first.
Just like you Treebeard, I too am just trying to find a safe, effective and beneficial surgical procedure to remove my remaining ‘multi level’ spinal stenosis. Neither do I have any ‘axes to grind’ for any clinic body or procedure.
However, after 7 years of research, all my findings show, that Minimally Invasive Spinal Surgery (MISS) and Transforaminal Endoscopic approach procedures TESS in particular are ‘by design’ the most safe, effective, reported and studied of all the available spinal decompression surgical options in the UK and abroad.
My last paragraph may seem impossible given how long the NHS have carried out decompression procedures, but I, and other members, have found that the biggest problem during research was the total inability to directly compare MISS and conventional procedures! This was/is due to ‘the very big ELEPHANT in the room’, the elephant that no one wants to take about!!
((The total lack of clinical, scientific, outcome and research information available, regarding all of the NHS’s spinal decompression procedures!))
GP’s
P.C.T. Clinical Directors
Orthopaedic Surgeons
Hospital Directors
Spinal Surgeons
Spinal Unit Heads and
Royal Colleges of Surgeons
Have all failed to supply me with a ‘single scrap’ of peer reviewed studies and published papers that confirms that NHS ‘gold standard’ decompression procedures are safe, effective or appropriate!!
The usual response has been along these lines:
((We do not have information on the various operations with regard to patients))
Or:
((We do not make, record or keep any safety and efficacy rates nor any results of trials regarding our decompression procedures))
So when the British Orthopaedic Association, the body responsible with the introduction of and quality control of spinal decompression procedures in the UK, carried out an specialist ‘literature’ assessment of Endoscopic Laser Foraminoplasty (ELF) on behalf of N.I.C.E in 2003,
[DLMURL="http://www.nice.org.uk/nicemedia/live/11028/30622/30622.pdf"] http://www.nice.org.uk/nicemedia/live/11028/30622/30622.pdf [/DLMURL]
[DLMURL="http://www.nice.org.uk/nicemedia/live/11028/30619/30619.pdf"] http://www.nice.org.uk/nicemedia/live/11028/30619/30619.pdf [/DLMURL]
they, I believe, knew ‘full well’ that ELF actually compared ‘very favourably’ with any of the ‘gold standard’ NHS procedures available at that time! Yet they still decided to limit it’s introduction! WHY?
I strongly believe that the study was fundamentally flawed,
Let me explain using this analogy:
If you walk in to a Vauxhall car dealership and ask the salesperson, which people carrier is the best?
a Vauxhall Zafira
Or
a Renault Scenic
The Salesperson ‘may well’ offer you a balanced opinion, but the obvious potential for ‘bias’ to cloud the opinion, is clear for all to see. The clear ‘conflict of interest’ is also obvious, this is why we tend to use ‘independent comparison web sites’ like WHICH and TOP GEAR.
But because we are talking about our beloved NHS, we disconnect our ‘critical analysing skills’ and simply go with Doctor knows best!
You said you and your wife live in the Manchester area Treebeard, so I was thinking, if you want see, first hand, the NHS’s views of MISS in general and Martin Knight in particular are, just ask your Wife’s Surgeon to referr her to Martin Knight, Then duck!!
I have had Senior Surgeons impugn MK’s name, personality, treatments and his professional international standing. One Spine Surgeon even suggested he had invented a brand new surgical procedure, simply to argue that his treatments were as good as MISS & ELF, he called it (MIOSS) Minimally Invasive ‘OPEN’ Spine Surgery !!!!!!!!!!!!???????? What theeeeeeeeeeeeee!!!!!!!!!!
Sadly Treebeard, it for these reasons, we are going to have to ‘agree to disagree’ about the authors intents. Sorry!!
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The link to the abstract of the German study that you supplied on your last post
([url]Full-endoscopic interlaminar and trans... [Spine (Phila Pa 1976). 2008] - PubMed - NCBI[/url])
was very interesting indeed, it is the clearest indicator yet of an increasing European acceptance of MISS’s parity with conventional procedures. Better still, was it’s conclusion that in some respects, MISS is superior in those areas you pointed out in your last post Treebeard.
Sadly, this is a German study, not British, and as we are some way behind the Germans, let alone the Americans, I feel it will still be a long time before we in the UK will benefit.
I still have some concerns regarding the lack of obvious direct comparison in this study, but it’s methodology appears to be much better than the first one you posted.
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pmc/arti...ticle_1155.pdf "> http://www.ncbi.nlm.nih.gov/pmc/arti...ticle_1155.pdf
So I too think it could be well worth while investing in a copy of full report! Thank you!
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1)
In regards to newer development over the last 3 years, the last incarnation of MISS from the USA is Trans-sacral Endoscopic Laser Spine Surgery, I’ll call it TELSS for short.
It involves gaining access to the spinal columns ‘working area’ by entering via ‘naturally existing’ holes (3 I think) in the ’sacral plate’ at the base of the spine, our old tail bone!
If the micro endoscopes, lasers, reamers and other tools can be safely fed through these holes to gain a access to and to be able treat the spinal columns vertebrae and disc issues,
TELSS has the potential to render TESS, ELFD and other MISS procedures ‘obsolete’ within 10 years, as it will not require any dissecting of any vertebrae nor of any the major muscle groups, including the vitally important fascias!!
This how far we are behind the world Treebeard!
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5)
With regards to the Randomised Control Trial’s (RCT’s) Surgeons not knowing important information about the patient including their names, just to tick boxes for the assessors, fills me with real fear & dread!!
Another contra-indicative issue is that as the NHS refuse to introduce MISS and TESS procedures, the cost of the bill for the RCT will fall on insurance companies or patients.
There is no way on earth, that I will pay £11-12,000 for possible ‘placebo’ spinal operation!
In addition, the first thing the Theatre Nurse will ask you on arrival, will be your name, age, home address and inside leg measurement! LOL!!
So I still maintain that the preposition of RCT’s for spinal surgery, is preposterous!!
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Got to go now Treebeard, I’ll speak to you soon!
All the best
SPINELF