Micro-spine-surgery and MISS Who really does this?

Hi friends.

Here are just a few fact based and researchable points to help with the confusion surounding competing spine surgery procedures. Whilst every one has veiws, a few things are absolutely clear and rooted in the truth.

With regards to the phrase Minimally Invasive Spine Surgery (MISS), it is important to understand the facts of true MISS, and the major problems with the โ€˜inappropriate wayโ€™ that the phrase is being used by Surgeons in the UK and around the world!

Because the phrase MISS has 'not been patented' to describe the most minimally destructive, least damaging, safest approach, leaving the patient with, maximum mobility, the best clinical outcome possible, with next to no collateral damage and using endoscopic visualization and possibly laser bloodless cuts, it has been 'hijacked' by Spine Surgeons around the world, irrespective of the actual techniques that they perform. I even came across a Surgeon advertising โ€˜minimally invasive intervertibral instrumented fusionโ€™. Outrages!!

I recently had a consultation with 2 Neuro/Spine Surgeons who described โ€˜NHS open back โ€˜decompressionโ€™ spine surgeryโ€™ as MISS, even though their procedure, sometimes also called โ€˜microdiscectomyโ€™, is actually โ€˜the sameโ€™ as โ€˜standard NHS open back surgeryโ€™ apart from a smaller incision (a min of 2โ€ instead of 4โ€) and the use of muscle spreading retractors. These retractors stretch and tear muscles, nerves and ligaments, and cause as much damage as open back procedures.

Evidence of its โ€˜poor reputationโ€™ came when these Surgeons told me that they โ€˜would not operateโ€™ on me, because as I was relatively young (52) and fit, they believed that the clinical outcome for me โ€˜would be poorโ€™.
If I were older and less fit, they โ€˜wouldโ€™ be prepared to operate!
So ask yourselves, if the young fit person who is capable of tolerating the trauma of the procedure, would 'not' have a good outcome, how the hell would an older, sicker and less fit person benefit from this procedure? The answer of course is,they usually donโ€™t, and re-operations are common place amongst this patient group.

So, why do these 'Surgeons' make these outrages and unfounded claims for their standard procedures? Well, I believe, that they have noticed the 'winds of change' blowing in from the US. The Medical Insurance Companies (like Medicare) have realised (at long last)
that patients who undergo 'standard' decompression, disc surgery and fusions were re-aplying for financial cover time and time again, and often without clear long term benefits. This of course lowers those companies profits. Because of the recent economic conditions they are now having to seriously consider either:
1) increasing the cost of customer subscriptions (unpopular & difficult).
2) find more cost effective treatments which reduce thier long term
exposure to repeated claims.
They have begun to decide to on (2), and as part of this, MISS has become more finacially atractive to insurers and patients alike, as time goes on, as these MISS procedure prove themelves more & more, it is the
insurance comopanies who will slowly, but surely, break down the stiff resistance of the medical establishment.

What the US do now, the UK will follow, and I believe that UK Surgeons are responding to this change, not by 're-training' in MISS, but by 're-branding' existing and standard spinal procedures as MISS instead. They will have to change in the future though, as the number of MISS clinics in the US, have increased 'dramatically' over the last 5 years, and profitable opportunities for American Surgeons to fill MISS gap in the UK, could spell the end of British Spine Units as we know them.

So dear fellow sufferers, before agreeing to Surgery described as MISS, demand that your Surgeon explain (in great detail) how he/she does the procedure, the initial incision size, the amount of muscle stripping/cutting, how do they cut a hole/window in the vertebrae, and do they use endoscope? and so on! If you get this detailed information out of them you, are doing well!!
but you do need this info, only then can you make an informed choice!!

----------------------------
As well as the Surgeons (ABOVE) who perform open back surgery and mis-describe their procedures as MISS, you must also be aware that there are important differences between Surgeons who do โ€˜genuinelyโ€™ offer, what could reasonably be called, MISS.

For example;

Some use a laser & powered reamers for cutting and trimming bones and discs, others might use just reamers.

Some use endoscopes for looking in to the spinal canal, and some use fluoroscopes โ€˜orโ€™ 3D computer aided visualization.

Some will use a laminectomy technique (cutting a hole in a, possibly healthy, vertebrae) as a way of accessing the spinal canal, whilst others will go through the foraminal opening, a naturally occurring hole in the vertebrae.

Some will utilize only 1 incision/hole to work though. Others use 2 holes, 1 for the endoscope and 1 for the cutting tools. Sometimes these 2 incisions/holes are on opposing sides of the spinal column.

The bottom line is, you have to do your โ€˜home workโ€™ on the MISS procedures & Surgeons available to you if you want to be sure of receiving the โ€˜most minimalโ€™ of available procedures. Otherwise, you may just wander โ€˜blindlyโ€™ in to a world of long term pain & suffering, after ineffective and repeated back operations!


See below for links to articles on different types of MISS clinics, locations, Surgeons, videos & procedural information!
(Cut & paste for direct access to MISS info)

www.zerospinepain.com

http://my.clevelandclinic.org/services/minimally_invasive_spine_surgery/sp_overview.aspx

http://www.spineuniverse.com/treatments/surgery/minimally-invasive-spine-surgery-information

http://www.spineuniverse.com/treatments/minimally-invasive-endoscopic-spinal-surgery

http://www.uchospitals.edu/specialties/minisurgery

http://health.ucsd.edu/specialties/miss

http://www.spinal-foundation.org

http://www.doctorbuzz.com/Procedures_java.htm

http://www.bonati.com

http://www.ehow.co.uk/facts_5915333_laser-spine-surgery-effective_.html

--------------------------

I have tried to look for evidence which would support the reason for carrying out โ€˜open backโ€™ and โ€˜microdiscectomyโ€™ in the NHS, but this is what NICE say!

โ€œDate notified to NICE:
18 June 2003
Topic area: Microdiscectomy:
Established procedure - Procedures do not fall within the Programme's remit if they are considered standard clinical practice with an efficacy and safety profile that is sufficiently well known.โ€


However, when I demanded to see these โ€˜sufficiently well knownโ€™ safety and efficacy rates, 4 of the biggest spinal units in the UK said, that they do not make, record or keep any such information on this procedure. So, the question is, where is the evidence that allows these spine units to continue with these โ€˜most destructiveโ€™ of spinal operations????

This link (BELOW), shows how NICEโ€™s special advisors reported on Endoscopic Laser Foraminoplasty (ELF)

http://www.nice.org.uk/nicemedia/live/11028/30622/30622.pdf


This link (below) shows how they reported on Intradiscal Electrothermal therapy (IDET)

http://www.nice.org.uk/nicemedia/live/11055/46396/46396.pdf


Please see the section (2.5 other comments) (IDET) at bottom of this report (below) and read what the specialist advisors say about the effectiveness of this procedure.

http://www.nice.org.uk/guidance/index.jsp?action=article&o=43964


What relevance do these articles have in relation to my point, I hear you ask?

Well, if you read these guidelines and reports, you will see, thatwhilst the introduction of minimally invasive (ELF), as pioneered by Mr. Martin Knight, has been, and still is being โ€˜actively resistedโ€™ by the medical establishment, (IDET) (a process of โ€˜cookingโ€™ a patients disc until โ€˜dryโ€™) has been embraced and carried out by at least 3 of my local Surgeons and many more around the UK!! NICE reports (IDET) as having less efficacy evidence to support its use than (ELF), in spite of having (apparently) more trials done on this procedure. WHY!!

It would seem to me that โ€˜whichโ€™ MISS procedures gets introduced in to every day medical use for the benefit of back pain sufferers, depends on what a Surgeon whim or on his/her ability, NOT on what is โ€˜theeโ€™ most minimally invasive, safest and effective treatments available for our conditions!!


I hope this helps.



All the very best, my fellow back pain sufferers

SPINELF
 
Huh, you said so much in just one post, so where to start...




Yes - there CAN BE minimally-invasive instrumentation and fusion.
Instrumentation and fusion causes a lot of tissue, muscle and disc damage, that is why they invented technology that can achieve all this without additional damage.

Yes - there CAN BE minimally-invasive tubular retractor assisted discectomy, decompression or foraminotomy.

DO NOT compare endoscopic and laser surgery with minimally-invasive surgery. There are many types of minimimally-invasive spinal surgery.

Do not disconcert the patients.



Do not call them surgeons who perform open back surgery. This is not true. As mentioned above, there are few types of minimally-invasive spinal surgery, and few techniques to achieve it.



Fluoroscope is integral part of all MISS and LISS procedures. For laser, endoscopic and micro-endoscopic spine surgery.


In almost all endoscopic cases, this has nothing to do with "some" surgeons. For disc herniation patients, type of surgery (interlaminar or tranforaminal) depend on herniation type and in some cases it depends on diseases level (L5-S1 cannot always be access in transforaminal way).

Please try no to misinform the patients. And let me conclude.

There are several ways of doing minimally-invasive spinal surgery. It would be good to divide MISS into:
-minimally-invasive spinal surgery (laser, endoscopic, percutaneous)
-less-invasive spinal surgery (some advanced surgeries done in minimally-invasive manner - for example stabilization, fixation, fusion, discectomy with tubular retractor, etc.)

Regards
 
I know you are passionate about informing people about MISS Keano, and thats good, but I can't help thinking you have missed the point of another post Keano.

I find some of your arguements confusing and contradictory, and I have to respond to a couple of them, as I am sure you have mis-informed menmbers.

Fusion is not, and never should be considered 'minimally invasive', because it totally restricts the bodies natural movement and usually requires a 2nd, 3rd and even 4th repeat procedures as it fundamentally
destroys the bodies physiology.

The use of any expanding retractors (as opposed to the tubular canulars in MISS) can and often does cause severe ripping, taring and general squashing damage to patients bodies. Not very minimal I say!

A Surgeon is a Surgeon irrespective of his technique or specialty. The point of my post was to warn people about 'assuming' that they all offer MISS, and also to 'empower them' to take the responsibility for research into their own hands, Not to disconcert them Keano.

Endoscopic visualisation of the area being operated on, is a 'feature' of minimally invasive spine surgery, because the images are taken from within the spinal cavity, mm's away from the disc or bone, and in full colour.
Flouroscopic and binocular images are taken from outside the body cavity, an external visualisation that is some times more than 12 inches away from the working area, and in the case of flouroscopes, images are in black and white!

I could go on Keano, but that would just confuse members more.

The reality is clear, the word 'minimal' means:

the least possible:
such as, the least posible damage to tissue, muscle and bone.
the lowest size:
such as, the lowest size of initial incision, MISS, less than half an inch.
the lowest quantity:
such as, the lowest quantity of operating time 'or' lossed blood.
the smallest amount:
such as, the smallest amount of aneasthetic 'or' recovery time.

If a potential patient is not offered 'this' it is not 'minimally invasive'.


All I am trying to say is, because Surgeons around the world are trying to 'appear' to be offering cutting edge, key hole, MINIMALLY INVASIVE spine surgery, are muddying the factual waters regarding procedures, and are mis-representing their procedures to back pain sufferers, we should all be vigillant and demand detailed information from our Surgeons to prove that what they acctually offer is MISS.

I hope this helps people.

SPINELF
 
Fusion is the last resort for patients with spondylolisthesis, FBSS (failed back surgery syndrome) and last stages of degenerative disc disease, etc. It is "invasive" surgery, and it can be done in completely minimally-invasive manner. Your state that it usually requires few procedures DO NOT STAND. Especially for patients with one-level fusion.


Not sure what are you talking about. I am always talking about MISS and LISS, and that includes ONLY tubular retractors. Never expanding retractors. One example of this retractor is METRx (minimum-exposure tubular retractor). I have attended few surgeries which utilized this technology and I can confirm this is pure state of the art minimally-invasive system. Expanding retractors are used in micro-spine surgery and that is considered as traditional open spine surgery.



This all stand, but why do repeat things that people can find just by writing all this terms in Google?

I am repeating, in your previous post you mentioned this:


Surgeons who use endoscope as working tool, ALWAYS use fluoroscope as navigation tool. You just fail to understand and you fail to listen to someone who know more.



Yes, I am witness of this. However, this is very rare situation. This is why I am working on several educational programs to help spine patients in deciding what is good and what is bad for them (considering their diagnosis).
 
I am afraid I have to disagree with many of you points Keano, and I also think you are getting tied up with the technical side of the procedures, rather than the difference it offers patients.

MISS is, as I say, means the least invasive and destructive 'of all possible' spinal surgical procedures, the clue is in the name.
LISS, means simply, that these procedures are less invasive and destructive than the worst possible surgical options.

Theres a big difference!

I am having to repeat myself because you are confusing the issues like the point that of visualisation and navigation, get a grip!

SPINELF
 
Whats the point of writing when you just fail to understand. Message for other members: read my previous posts, you'll find some useful and correct information about minimally-invasive spinal surgery...
 
Looks like you'll need to agree to differ folks. Please remember to 'play nice'.

Thanks
Moonfairy
HPmods
 
Hi guys

So would for instance MK use a flouroscope to see where to place the endoscope in the body, (the angle depth etc) then use the camera inside the endoscope for the actual surgery?
I think the NHS use just a flouroscope if anything then open/stretch the back wide enough to see and still call it MISS!
 
I finally got to see the orthopaedic surgeon my GP referred me to (nearly 3 months ago now) and what a let down it was ! The appointment was 90 minutes late then and all I got was 10 mins of their time . Even worse, it wasn't the surgeon who saw me, but one of his assistants or juniors

Anyway, they've recommended a discectomy and wallis ligament (some kind of synthetic spacer designed to stabilise the spine). The operation is around an hour long they said, but I'd have to stay in hospital for 3-4 days. They also gave me a list of risks and complications. These included among others a 5% chance of dura tear and a 5% chance of a recurring disc herniation. Those look like very big numbers to me, much bigger than those quoted by MISS practitioners. So I wasn't impressed at all by the NHS, not by their surgery, nor their treatment of patients.
 
{{{{{{{{{{{{{{{Jim}}}}}}}}}}}}} I am so sorry, I know you were hoping for so much more, and you deserve so much more too.

I am sure you will have searched and found this article but it may be intersting to hear other's views on it? http://www.spinalsurgerynews.com/articles.php?key1=4&key2=1
 
Dural tear is usually not dangerous and will not cause permanent damage.

Biggest problem is FBSS (failed back surgery syndrome). With traditional surgery, it occurs in 20-40% of patients (depending on study). FBSS includes post-laminectomy syndrome, reherniation, adhesions, fibrosis, scar tissue, etc.
 
Thanks Cassie. I had a look at that article and it says the wallis ligament is only used at levels down to L4/L5, but contraindicated for L5/S1 (where my disc compression is). If that's true, then why have the NHS recommended it for me? Actually, it doesn't surprise me. At first they said surgery wouldn't help me, then after disappearing into a different room to look at my MRI on screen, the consultant came back and changed his mind "actually your prolapsed disc is big enough to warrant surgery". That really inspires confidence, huh ?

Anyway, although I'm disappointed with the NHS, I'm not downhearted. It's actually reassured me that MISS is the way to go.
 
Will your possible MISS surgery be covered by your insurance company?
 
Sadly I don't have insurance, Keano. So I'll have to find the money myself. But if I get my life back, it'll be the best 10k I've ever spent.
 
What Mr. Knight told me was, that he used the flouruoscope to track the insertion of the initial thin wire, that created the route from the initial incision (2 inch right of the mid line) down to the foraminal opening.
Once he had passed the the increasingly larger canulars/tubes to make the 7.5 mm working hole, and had passed the micro endoscope down the hole,he said he no longer needed the flouroscope.

Hope that helps


SPINELF
 
Yes Elfy, that does, now if only we could somehow persuade the nhs to take up MISS preferably with MK.....other methods seem so barbaric!
 
Shoutbox
  1. wilson holistic centre:
    new girl works at ๐Ÿ’‹535 Evans Ave today ๐Ÿ’•๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-531-6969โ˜Ž๏ธโ˜Ž๏ธ
  2. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน Table shower .body scrub ๐Ÿ˜˜Three girls every day ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ 5124 Dundas West Street, Etobicoke โ˜Ž๏ธ 416-817-3366 ๐Ÿ‘ Newโ—๏ธNew girl Angela ,so young Petite and pretty๐Ÿ˜‹ open service ๐Ÿ˜œ๐Ÿ˜œ Sweet girl Luna deep massage ๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ Hot and sexy body very provocative service ๐Ÿ˜๐Ÿ˜๐Ÿ˜๐Ÿ˜โค๏ธ You are welcome to make an appointment at any time or walk in directly through the back door. We have ample parking spaces available
  3. Sabrina Fox:
    I'M HOT BUSTY AFRICAN GIRL AVAILABLE AT WESTON & ST. CLAIR. LETS HOOK UP! ๐Ÿ“ž 647-271-9648
  4. Withme_Spa:
    ๐Ÿ’ฏ๐Ÿ’ฅ๐Ÿ’ž4386 Sheppard Avenue east โฃTuesday, โฃ๐Ÿ’ž Mia,๐Ÿ’•๐Ÿ’‹ petite Taiwanese, sexy build with beautiful face. friendly, very relaxing treatment and wonderful finish. ๐Ÿ’˜๐Ÿ’‹ Coco,โฃtall , slim, curvy, pretty girl with long hair. Soft treatment and very nice finish. โฃโค Eva, ๐Ÿ’‹๐Ÿ’‹medium height, nicely rounded and curvy, enjoys giving and receiving erotic touch ๐Ÿ’žJessica,๐Ÿ’‹ medium height, sexy build with shapely legs and ass. friendly, relaxing finish๐Ÿ”‹416 297-7488๐Ÿ”‹
  5. ใ™ใฟใพใ›ใ‚“:
    Gabby , sunny , larissa , lora, michelle , christine on duty at top notch.
  6. lemon_tree:
    ๐Ÿ’›๐Ÿ’ฅa discreet entrance to 4155 Sheppard Avenue east, unit 201๐Ÿ’—๐Ÿ’žโฃ๐Ÿ’‹Tuesday, โฃ๐Ÿ’ž Holly, ๐Ÿ’‹medium height and sexy build with shapely legs and ass. friendly, does a very relaxing treatment and wonderful finish . ๐Ÿ’˜๐Ÿ’ฅ ๐Ÿ“ž 647 348-2899๐Ÿ“ž
  7. Nu spring spa888:
    โค๏ธโค๏ธโค๏ธsexy hot Germany๐ŸŒธKorean ๐ŸŒธViennese girl working at๐Ÿ’“๐Ÿ’“ Nu spring spa โ˜Ž๏ธ416-669-8508โค๏ธโค๏ธโค๏ธ
  8. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Click Here Today๐ŸŒธSusan๐ŸŒธLuna๐ŸŒธXuka๐ŸŒธLynda๐ŸŒธBrandy Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  9. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–Tuesday ๐Ÿ’œ Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: SL Richmond Hill & SL West Oakvilleโœจ Your passport to paradise with 10 enchanting girls fr China, HK, Japan & Korea โ€” ๐Ÿ†• Aliyah, Lucy, Cindy, Yui, new Jojo, Coco, Cici, busty Amber, Kelly & Jasmine โ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awai
  10. SpringGreen.:
    Apple off your weeked with a bang๏ผ Judy is at spring green in downtown toronto Tuesday from 9am-9pm with apple and coco. apple is a very beautiful andcaring young lady๏ผkitty is super hot.๐Ÿ’‹๐Ÿ’‹647-891-0699 ask and text questions thanks๐Ÿ’‹๐Ÿ’‹
  11. wilson holistic centre:
    new girl works at ๐Ÿ’‹535 Evans Ave today ๐Ÿ’•๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-531-6969โ˜Ž๏ธโ˜Ž๏ธ
  12. Spa in Markham:
    GOLDEN FS โ€“ 8380 Kennedy Rd ๐Ÿ“ž 905-258-0777 / 416-688-6886 ๐Ÿ‡ธ๐Ÿ‡ฌ CANDY, ๐Ÿ‡ญ๐Ÿ‡บ VANESSA, ๐Ÿ‡จ๐Ÿ‡ด MEGAN (2AM), ๐Ÿ‡ป๐Ÿ‡ณ JULIE (8PM) ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookinggoldenlove
  13. FLOWER Spa - BLUEXADO | Thornhill | VAUGHAN:
    BLUEXADO FS โ€“ #06-1102 Centre St ๐Ÿ“ž 416-357-9797 / 416-678-8668 ๐Ÿ‡ป๐Ÿ‡ณ CICI, ๐Ÿ‡ป๐Ÿ‡ณ MY LINH, ๐Ÿ‡ป๐Ÿ‡ณ AMY, ๐Ÿ‡ป๐Ÿ‡ณ SHERRY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingbluexadolove
  14. Red Rose Spa:
    ๐ŸŒธ We have 13 hot brown girls today ๐ŸŒธ MONICA, ASHA, MALIYA, MONIKA, ANGEL, MIMI, PREETI, ANGELINA, DIYA, PAYAL PEARL, KIRAN ๐ŸŒธ 2588 Birchmount ๐ŸŒธ 2 Invergordon ๐ŸŒธ 647-702-8800 ๐ŸŒธ Please visit for a great erotic massage
  15. FLOWER Spa โ€“ PINK | Scarborough | TORONTO:
    PINK FS โ€“ 3300 McNicoll Ave ๐Ÿ“ž 416-299-5515 / 416-817-3839 ๐Ÿ‡ฎ๐Ÿ‡ท ELINA, ๐Ÿ‡ป๐Ÿ‡ณ KELLY, ๐Ÿ‡ต๐Ÿ‡ญ MADY (1PM) ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingpinklove
  16. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  17. DareDevil:
    ARIA WELLNESS ๐Ÿฌ๐ŸญADDRESS: 360 HWY 7, UNIT #6, โ™ฅ๏ธRICHMOND HILL,647-222-5683 (PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : Yoga Lucy, Killer Kelly, Adorable Eva, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! BUY 10 HOURS (GET 11 HOURS) **TODAY'S PICK OF THE DAY ARE ๐Ÿฌ๐ŸญLUCY AND KELLY๐Ÿฌ๐Ÿญ**
  18. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Click Here Meet๐ŸŒธNina๐ŸŒธAnna๐ŸŒธAmberCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  19. AliceSpa:
    TUESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—”, 4915 Steeles Ave. E, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿฎ๐Ÿต๐Ÿด-๐Ÿฌ๐Ÿด๐Ÿต๐Ÿด. 3 Young Beauties Today at Alice Spa. Open 10am to 9pm: CLOUDIA (10am-9pm): is Vietnamese, young, petite 5'2" & 96 Lbs, B Cup, best rim deep bbbj cim. $40 Room Fee + $80 (incl bbbj & fs). +$20 for rim/cim. Excellent open minded services. KITTY (1pm-9pm) is a new Korean girl, super busty, small body, new
  20. wonderspa:
    ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Tuesday RMT available,๐Ÿ’„sexy very young girl Mimi๏ผŒlong legs ,natural c cup,very good looking amazing massage nice body slide,really popular ๐ŸŽlong hair Lucy Q smile,very good looking ,strong to relax oil ,back walk,more experience,relief your pain,amazing ending๐Ÿ”ฅ๐ŸŒน๐ŸŒนmust try
  21. ForeverWarden:
    Tuesday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Cindy, Tracy & Vivian. Cindy is a slim beauty, 5โ€™4โ€, natural C Cups. Her massage is nice, her services will drive you wild & her finish is a dream come true. Tracy is an incredibly cute & pretty Japanese/Taiwanese mixed spinner, about 5โ€™1โ€ and 100 lbs. She is very popular for her exotic massage & services.
  22. HolidaySpa:
    Tuesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: EMMA, JENNY & CINDY. EMMA is a very beautiful slim Chinese honey with C Cups, beauty face, & nice services to drive you wild. Jenny has a medium build, nicely curvy with a slim waist, pretty face, and very flexible skills. Jenny will make you very happy. CINDY is slim & incredible
  23. SugarLoveSpa:
    Tuesday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: CHRISTINA, JENNY, TIFFANY & VIVI. 1270 Finch Ave W (at Keele St), Unit 18. North York. CHRISTINA is Spanish, C Cups, 5'3", tall & nice curves, very open minded. JENNY is a sweet & young Korean girl with C Cups. Very versatile services. TIFFANY is an amazing slim petite doll with natural 34C melons, slim waist, & a cute little 33โ€ booty.
  24. bnwellness_wilson:
    We have 4 young girls are working today, young pretty new Eva 30โ€™s with curve body open mind and young flirty Mia 25โ€™s with curly body , young sweet Sophia with slime body and cute GFE Lina are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
  25. Red_Pearl_Spa:
    โค๐Ÿ’‹4385 Sheppard Avenue east, unit 5๐Ÿ”บ๏ธ๐Ÿ’‹โฃ๐Ÿ’‹๐Ÿ”ดTuesday, ๐Ÿ’˜๐Ÿ’• Kim, โฃtall and slim, long dark hair, very pretty. Good relaxation and nice finish. ๐Ÿ’ž๐Ÿ’‹ Kelly, ๐Ÿ’‹today for an amazing treatment... 5'5", long light brown hair, at least C's ๐Ÿ’‹โฃ โ˜Ž๏ธ 647 352-1588โ˜Ž๏ธ
  26. gold__rose__spa:
    ๐Ÿ’๐Ÿต1536 Warden Avenue ๐Ÿ’ž๐Ÿ’ฅ๐Ÿ’‹Tuesday, โฃ๐Ÿ’‹ Jessica,๐Ÿ’— shapely, pretty, comfortable treatment, great service for more traditional style treatment and quality services. ๐Ÿ’ž๐Ÿ’–Fifi, solid body, ๐Ÿ’๐ŸŒน ๐Ÿ“ณ 647 346-8086๐Ÿ“ณ
  27. Lulu_Villa_Spa:
    Suki From Taiwan, sweet girl Cherry ๐Ÿ’ From Malaysia Part time School girl Sami is a gorgeous model type Vietnamese Girl Natalie she is CBC/filipina mixed Petite girl โ˜Ž๏ธ647- 446-0886
  28. luckywellness:
    Lucky Wellness Center 4379721888 295 Eglinton Ave E,Unit 7,Mississauga Kik and Bella work we are have good full body relaxing massage and Deep Tissue Massage
  29. Annie Spa:
    ๐Ÿ’‹Gorgeous Young New Tight Korean Butt Yumi working with Sexy Busty Boobs Angel and Sensual & Pleasing Busty Boobs Coco today๐Ÿ’‹ Call or text๐Ÿ“ฒ647-891-9688 or 416-291-8879๐Ÿ“ฒ
  30. Double_Tree:
    โค๐Ÿ’ข4271 Sheppard Avenue east ๐Ÿ’ž๐Ÿ’–โฃTuesday,๐Ÿ’–๐Ÿ’— Nina, ๐Ÿ‘Œtall and full build, very experienced touch that will relax you and relieve all stress.โค๐Ÿ’ฅ โ€ŠXixi,๐Ÿ’‹ medium height and build and nicely curved. Pretty, dark hair to shoulder. over the top finish+. ๐Ÿ’‹๐Ÿ’ฅ ๐Ÿ“ž 416 293-5071๐Ÿ“ž
  31. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน Table shower .body scrub ๐Ÿ˜˜Three girls every day ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ 5124 Dundas West Street, Etobicoke โ˜Ž๏ธ 416-817-3366 ๐Ÿ‘ Newโ—๏ธNew girl Angela ,so young Petite and pretty๐Ÿ˜‹ open service ๐Ÿ˜œ๐Ÿ˜œ Sweet girl Luna deep massage ๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ Hot and sexy body very provocative service ๐Ÿ˜๐Ÿ˜๐Ÿ˜๐Ÿ˜โค๏ธ You are welcome to make an appointment at any time or walk in directly through the back door. We have ample parking spaces available
  32. DareDevil:
    ARIA WELLNESS ๐Ÿฌ๐ŸญADDRESS: 360 HWY 7, UNIT #6, โ™ฅ๏ธRICHMOND HILL,647-222-5683 (PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : Yoga Lucy, Killer Kelly, Adorable Eva, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! BUY 10 HOURS (GET 11 HOURS) **TODAY'S PICK OF THE DAY ARE ๐Ÿฌ๐ŸญLUCY AND KELLY๐Ÿฌ๐Ÿญ**
  33. DareDevil:
    Blackpink Wellness โ™ฅ๏ธโ™ฅ๏ธ90 Marycroft Ave. Unit #2, Vaughan, ๐Ÿญ๐ŸฌON L4L 5Y1 (647) 395-3188. BEAUTIFUL AND SEXY GIRLS TODAY: Superstar Bobo, New Pretty Amanda, New Indian Girl Radika and Beautiful Tiffany on duty๐ŸŒน.
  34. pickyreviewerr:
    Blackpink wellness center in Vaughan - 647-395-3188 four Amazing girls to serve you today. Newly renovated, great rooms with shower ๐Ÿ˜ ๐Ÿ˜ ๐Ÿ˜ :heart5
  35. Sunrise Relaxation(416)916-7276:
    Tomorrow@Sunrise Relaxation Downtown: โค๏ธAngela, โค๏ธOlivia, โค๏ธLisa and โค๏ธKitty will be on shift. Call (416)500-0921 for detail schedule and insight info
  36. EMSpa_schedule:
    Tomorrow's sneak peek: On Tuesday May 27, 2025, our attendants will be Ada ๐Ÿคฉ, Christina ๐Ÿ‘, Cici ๐Ÿคฉ, Ivy ๐Ÿ˜, Monica ๐Ÿ˜ and Connie ๐Ÿคฉ. Call us at โ˜Ž๏ธ(905) 479-6668โ˜Ž๏ธ to book!
  37. wilson holistic centre:
    new girl works at ๐Ÿ’‹535 Evans Ave today ๐Ÿ’•๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-531-6969โ˜Ž๏ธโ˜Ž๏ธ
  38. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–Monday ๐Ÿ’œ๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: SL Richmond Hill & SL West Oakvilleโœจ Your passport to paradise with 10 enchanting girls fr China, HK, Japan & Korea โ€” Top Star Jenny, ๐Ÿ†• Elsa, Coco, Eva, Cindy, Kelly, Amber, Busty Echo, Yoyo, JPN Yui & Juliet โ€” ๐Ÿ๐ŸŽˆ Hit up 647-695-6354๐Ÿค™ or text to ๐Ÿ“ฑ647-578-8169 โœจ160 East Beaver Cr., Unit 12, Richmond Hill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  39. wilson holistic centre:
    new girl works at ๐Ÿ’‹535 Evans Ave today ๐Ÿ’•๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-531-6969โ˜Ž๏ธโ˜Ž๏ธ
  40. wonderspa:
    wonderspa: ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,๐Ÿ’„sexy very young girl Mimi๏ผŒlong legs ,natural c cup,very good looking amazing massage nice body slide,really popular ๐ŸŽlong hair mina smile,very good looking ,strong to relax oil ,back walk,more experience โค๏ธvery sexy Vietnamese girl Amy,open maid,amazing the end,really popular,must try๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿฅคall awesome massage ๐Ÿ‘๐ŸŒน๐ŸŒน
  41. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Click Here Today๐ŸŒธSamy๐ŸŒธPriya๐ŸŒธLynda๐ŸŒธAletta๐ŸŒธIsabella๐ŸŒธIvy Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  42. DareDevil:
    366 ARIA WELLNESS โ™ฅ๏ธโ™ฅ๏ธADDRESS: 360 HWY 7, UNIT #6, RICHMOND HILL,647-222-5683 โ™ฅ๏ธโ™ฅ๏ธ(PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : New young RMT student Helen, Fun girl Apple, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! SPECIAL PROMO 30 MINS 2 GIRLS $70 ๐ŸŒน๐ŸŒน**TODAY'S PICKS OF THE DAY ARE ๐Ÿฌ๐Ÿญ APPLE AND HELEN๐Ÿฌ๐Ÿญ**
  43. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Click Here Meet๐ŸŒธCarly๐ŸŒธBrandy๐ŸŒธKellyCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  44. Spa in Markham:
    GOLDEN FS โ€“ 8380 Kennedy Rd ๐Ÿ“ž 905-258-0777 / 416-688-6886 ๐Ÿ‡ญ๐Ÿ‡บ VANESSA, ๐Ÿ‡ป๐Ÿ‡ณ JULIE (2PM), ๐Ÿ‡จ๐Ÿ‡ด MEGAN (8PM), ๐Ÿ‡ป๐Ÿ‡ณ KELLY, ๐Ÿ‡ฎ๐Ÿ‡ณ SONIA (8PM), ๐Ÿ‡ป๐Ÿ‡ณ JESSIE ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookinggoldenlove
  45. FLOWER Spa - BLUEXADO | Thornhill | VAUGHAN:
    BLUEXADO FS โ€“ #06-1102 Centre St ๐Ÿ“ž 416-357-9797 / 416-678-8668 ๐Ÿ‡ป๐Ÿ‡ณ CICI, ๐Ÿ‡ป๐Ÿ‡ณ AMY, ๐Ÿ‡ป๐Ÿ‡ณ SHERRY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingbluexadolove
  46. FLOWER Spa โ€“ PINK | Scarborough | TORONTO:
    PINK FS โ€“ 3300 McNicoll Ave ๐Ÿ“ž 416-299-5515 / 416-817-3839 ๐Ÿ‡ฎ๐Ÿ‡ท ELINA, ๐Ÿ‡ต๐Ÿ‡ญ MADY, ๐Ÿ‡ธ๐Ÿ‡ฌ CANDY, ๐Ÿ‡ป๐Ÿ‡ณ NANCY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingpinklove
  47. SpringGreen.:
    Today we have 5 girls on downtown Toronto 72 gerrard st west๏ผš๐Ÿ’‹๐Ÿ’‹ New girl Hitti very young๐Ÿ’‹๐Ÿ’‹Lisa- Tanned Spanish beauty with large melons and a fun booty too minica- exotic goddess with a gymnasts body and corresponding flexibility Jennifer- Exotic beauty with... Call and text 647 891 0699 ask question :heart4 :heart4 :heart4
  48. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  49. AliceSpa:
    3 Sexy Young Girls Today at Alice Spa. Open 10am to 9pm : CLOUDIA (12pm-9pm): is Vietnamese, young, petite 5'2" & 96 Lbs, B Cup, best rim deep bbbj cim. $40 Room Fee + $80 (incl bbbj & fs). +$20 for rim/cim. Excellent open minded services. SKY (10:30am-9pm): is Part time girl from Indonesia, petite 5'2", B Cup, 100 Lbs, long black hair, new to the biz.Young, fresh/cute, pretty, submissive, slim tiny waist, fair skin. bbbj
  50. ForeverWarden:
    Monday at ๐Ÿซฆโค๏ธ๐Ÿ”ดโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ 2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Bella, Yumi & Cindy. Bella is around 5โ€™3โ€ with a thin to medium build, C Cups, and a pleasing personality. She can offer dfk, bbbj and cfs as well as a good massage experience. Yumi is a young half Chinese / /half Korean very sexy & slim beauty, can do bbbj cim, excellent services...
Back
Top