Raymond Gardocki M.D.

04/04/2026

Endoscopic Thoracic discectomy for giant calcified thoracic disc herniation

04/04/2026

For thoracic disc herniations that are amenable, endoscopic thoracic discectomy significantly decreases morbidity and speeds recovery compared to traditional open approaches for decompression ventral to the thoracic cord. However, giant calcified thoracic disc herniations with neurological symptoms pose risks regardless of the surgical approach and may be better addressed with more invasive techniques.

An exception exists for giant calcified thoracic discs where the apex of the herniation is lateral to the cord, allowing the herniation to retract the cord which enables a transforaminal approach. In experienced hands, with the proper trajectory and facet resection, these can often be decompressed endoscopically without the need for instrumentation, providing all the benefits of an ultra-minimally invasive approach.

Included below are pre and post-operative imaging for an early 50s male with a lateralized giant thoracic disc herniation that was resected using the Arthrex Spine 30 degree scope and the 3.0mm NSK diamond bur. The immediate post-operative CT shows complete resection of the calcified mass with decompression of the canal.

I will be discussing the cost-effectiveness of advanced endoscopic spine surgery at the ISASS 2026 annual meeting next week.

10/17/2025

Magic Schoolbus tour of the transforaminal endoscopic approach.

This is literally how I visualize the structures in the transforaminal approach, as if I were standing on the disc is the foramen and looking around. Special thanks to Arthrex Spine for making my dream a reality.

Raymond J. Gardocki, MD (Nashville, TN), provides an in-depth overview of the anatomical orientation through an endoscope lens during an endoscopic transforaminal approach for discectomy.

10/06/2025

A recent article published in IJSS found that 2/3 of spine surgeons surveyed would opt for endoscopic spine surgery for their disc herniation, even though only 37.1% of them routinely perform this procedure. This begs the question: what paradigm should be considered when determining surgical indications?

I think the amswer to that question is very straightforward and centuries old:

Do unto others as you would have done unto you.

This is why I do endoscopic spine surgery.

Background Endoscopic spine surgery is a minimally invasive approach that offers several advantages over the traditional open approach, including less tissue trauma, faster recovery, and lower rates of complications. However, the learning curve and the requirement of separate equipment limits the ac...

05/26/2025

I am very proud to announce my inclusion as one of the top 2-3% Orthopedic Surgery Research All-Stars for 2025!
This honor is in recognition of the quantity and quality of the Orthopedic Surgery research authored and published last year.
The Healthcare Research All-Star lists are compiled by -garde Health and include only the top 5% of hospitals and physicians publishing leading-edge research in Orthopedic Surgery care. You can review the full list HERE.

05/15/2025

Can giant calcified thoracic discs be adequately addressed ustilizing an endoscopic approach?

I think they can. These are risky and challenging cases no matter how they are done, but the benefits of an ultra minimally invasive uniportal endoscopic approach for this pathology are obvious when compared to the morbidity profile of any other surgical technique. We have also shown tremendous cost savings when comapring the endoscopic approach to a traditional open approach requiring fusion.

https://lnkd.in/d5VZYKhH

Here is a 49yo physician with a giant calcified thoracic disc herniation with surprisingly mild myelopathy symptoms. She had a giant calcifed T7-8 herniated with severe cord impingement that was addressed through a right sided endoscopic approach under general anesthesia with neuromonitoring with excellent results. Patient stayed in the hospital overnight and rode home (out of state) the next morning. Incision picture was POD #1 before discharge. She went back to work within two weeks and didn’t need narcotics.

This is a true paradigm shift.

04/27/2025

The Spine as a Crane: A Biomechanical Analogy

The lumbar spine and multifidus muscle work together like a mechanical crane to ensure stability. The lumbar spine, like the crane’s tower, provides structural support for the torso. The multifidus muscles act as guy wires, tensioning the spine to increase stiffness and prevent buckling during heavy lifts, much like the cables that stabilize a crane under load.

But what happens if the guy wires fail? Weakened wires reduce the crane’s stability, which can lead to collapse under load. Lumbar spine surgery can damage the multifidus, akin to weakening or shortening a crane’s cables. A compromised multifidus muscle complex leads to spinal instability, causing pain, excessive motion, or injury during loading. If the wires don’t span the full tower—mimicking multifidus dysfunction—unsupported segments face stress, risking structural failure.

Post-surgery, rehabilitation is key to strengthen the multifidus and restore spinal stability, just as a crane needs repaired cables to function safely. This analogy highlights the importance of preserving these critical stabilizers and why I make every effort to spare the multifidus during minmally invasive and endoscopic spine surgery.




For those who want to learn more about the structure and function of the multifidus muscle, here is a paper co-authored by Dr. Choll Kim, Spine Surgeon:

https://pdfs.journals.lww.com/jbjsjournal/2009/01000/architectural_analysis_and_intraoperative.22.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1745767830342;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL73hiPqJliudqs17cHeLcLbV/CqjlP3IO0jGHlHQtJWcICDdAyGJMnpi6RlbEJaRheGeh5z5uvqz3FLHgPKVXJzd3q8SQSgPZSBPpzHLmT+EuxESHqWcmdWSO5+px6umR1Kxd89kqvY42JV6he9UXSYL;hash|kfL4dirxJifJsf4IbdCZLQ==

https://m.youtube.com/shorts/tVGAjJkCj3c

04/11/2025

It was an honor to get the opportunity to speak about outpatient spine surgery and endoscopic treatment of giant calcified thoracic discs at ISASS 2025.

11/14/2024

“Mobey Disc”

11/14/2024

53yo male with left C6 and C7 radiculopathy with 8 months of 7/10 pain in the neck and arm unresponsive to physiotherapy, injections, medications, massage, and chiropractic treatment.

Diminished reflexes in the LUE and weakness in wrist extension, wrist flexion and triceps led to a two level posterior cervical foraminotomy/discectomy at C5-6 and C6-7. This surgery was done outpatient without the need for post operative narcotics or activity restrictions. The pre op and post op pain diagrams, the MRI and the single incision at 3 months is included in the pictures.

You can no longer have a discussion of motion, preservation technology in the cervical spine, that including endoscopic posterior cervical foraminotomy with or without discectomy.

Keep an eye out for our cost paper comparing endoscopic posterior cervical foraminotomy and microscopic posterior cervical foraminotomy coming out in Operative Neurosurgery soon.

09/21/2024

I am committed to educating others on the intricacies of uniportal endoscopic spine surgery, aiming to establish it as the gold standard of care.

Raymond J. Gardocki, MD (Nashville, TN), demonstrates how to adapt the trajectory for different herniation locations when performing a transforaminal endoscopic discectomy.

09/18/2024

What motivates you to go to work in the morning?

Messages like this one are the reason I jump out of bed every day:

A post-operative incision and a recent message from a patient who underwent a two-level posterior cervical foraminotomy. She recovered remarkably quickly from the cervical surgery and was so pleased with the outcome that she elected to evaluate her low back and leg pain with an MRI. Results like this fuel my commitment to advocating for endoscopic spine procedures.