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Published on April 25, 2016

Cape doctor leads the way in spine surgeryCape doctor leads the way in spine surgery

Transforaminal endoscopic discectomy is quite a mouthful, but the new procedure is music to the ears of patients suffering from a herniated disc.

Paul Houle, MD, FAANS

Hyannis neurosurgeon Paul Houle, MD, FAANS, of Cape Cod Healthcare Neurosurgery was the first to perform the minimally invasive surgery in Massachusetts.

“It’s a new technique that allows us to do some things that we couldn’t do before,” said Dr. Houle. “Patients love it.”

Transforaminal endoscopic discectomy, or the “Joimax procedure,” as it is more commonly known, involves using an endoscope to remove fragments of a herniated disc. The procedure is performed using a small incision in the patient’s side, which allows the surgeon to reach the disc while avoiding ligaments, muscles and bones.

“Not only do we avoid destroying the muscles in the back, we avoid them altogether,” said Dr. Houle. “By exploiting the natural holes, so to speak, in the spine, you can access the areas where the discs tend to herniate. By doing as little damage to the spine as possible to accomplish our surgical goals, the better the patient will do.

“I’ve always done minimally invasive surgery, trying to spare some of the very important muscles of the back so people don’t have a lot of back pain after surgery. This is an extension of that.”

Herniated discs can be caused by trauma or excessive lifting, but they are usually degenerative in nature – resulting from wear and tear over the years. A herniated disc bulges from its usual position, which puts pressure on spinal nerves and can cause tremendous pain in the lower back or legs.

The Joimax procedure has been performed in Europe for about a decade. Dr. Houle learned the technique from two doctors who are experts at performing the surgery during a week-long fellowship tour in Germany and the Netherlands.

“The purpose of the trip was to see people who had done thousands of these procedures, who really helped pioneer it in Europe, and see how they treat their patients, because this is a universal problem,” he said.

Dr. Houle performed the surgery at Cape Cod Hospital for the first time last summer and has since done the procedure almost 50 times.

One of only about 40 U.S. surgeons performing this form of discectomy, Dr. Houle recently traveled to Los Angeles to collaborate with a German doctor to train an international group of neurosurgeons in the procedure.

“Neurosurgeons don’t like to do new things because the consequences can be huge,” said Dr. Houle. “But if there’s a better mousetrap, we want to use it.”

Because the technique is less invasive than other types of disc repair, it has several advantages. Anesthesia is not needed. Instead the sedated patients are awake and able to respond during surgery.

“If the nerve is irritated, the patient can respond,” said Dr. Houle.

The procedure is extremely well tolerated, he said.

“There isn’t a lot of pain that goes along with it. That means we’ve able to cut down the amount of narcotics we prescribe after surgery.”

Patients can go home the same day, usually within an hour or so of surgery. Recovery is greatly accelerated, with patients making a rapid return to everyday life.

According to Cape Cod Healthcare Neurosurgery website, traditional methods of discectomy have a success rate of 75- 85%, while studies have shown a success rate of over 93% for the new endoscopic technique.