What is endoscopic surgery?
Endoscopic Spine Surgery is a minimally-invasive spine surgery used to treat back pain, leg pain, numbness and weakness, bone spurs, bulging discs, stenosis, herniated discs, facet joint disease, sciatica, scoliosis, spondylolisthesis, and more.
The procedure requires a skin incision less than 1-inch and is done through a tube between back muscles to decrease muscle damage and weakness caused by muscle retraction. Minimally-invasive surgery is not the same as “microsurgery”. “Microsurgery” only refers to the use of a microscope, not the size of the incision or the amount of muscle damage.
This procedure allows a tube the size of a pencil to be inserted into the spine through an incision approximately 7mm in size. The muscles are not cut or torn but pushed to the side to allow this small tube to enter the spine. From there, we use a very small high-definition camera to see the spine anatomy. Most patients will have immediate pain relief.
For example, a herniated disc pinches the nerve, causing back and leg pain called sciatica. This burning, stabbing pain can be very debilitating to a person. During traditional spine surgery, an incision is made and a retractor is placed retracting the multifidus spinal muscles. The multifidus muscle injury is decreased with minimally-invasive spine surgery. Bone and ligaments are then cut away to expose the nerves, increasing the risk of scar tissue. The nerve root is then gently pulled to the side and the disc is removed to decompress the nerve.
The endoscopic technique bypasses all of the above, we take advantage of an opening that already exists in the side of the spine called the neuroforamen. Often, we’ll enlarge that opening by only a few millimeters to make even more room for the nerve and then remove the ruptured disc without retracting or injuring the muscles.
How is endoscopic laser spine surgery different than minimally invasive surgery?
Endoscopic spine surgery is what most spine surgeons would consider the ‘ultimate’ method of minimally-invasive spine surgery. A camera is inserted through a very small incision to the damaged area of the spine. The camera projects the images onto a video screen so the surgeon can easily visualize the pathology. Tiny instruments are inserted through the camera to repair the spine under direct visualization. The media often emphasizes lasers, but they are only one of many endoscopic instruments.
Why is endoscopic spine surgery better than traditional surgery?
Traditional surgery is limited because the surgeon requires a direct vision of the pathology with their eyes or microscope. The endoscope camera visualizes areas that are not usually accessible, through the nerve root foramen and around corners.
Traditional surgery is more destructive to the spine. The larger the incision, the more damage to muscle, ligaments, and bone. This collateral tissue damage may result in more pain, back muscle weakness, instability, and scar tissue leading to future difficulties.
Endoscopic spine surgery is minimally-invasive. The incision is very small, often less than 1 cm in size. There is minimal damage to skin, muscle, ligaments, and bone. No general anesthesia is required for decreasing medical risks and improving access to surgery for high-risk patients. There is very little blood loss. These benefits result in less post-operative pain and quicker recovery.
What types of conditions can endoscopic spine surgery treat?
Treatment is effective for conditions that cause back pain, leg pain, numbness and weakness, such as bone spurs, bulging discs, herniated discs, facet joint disease, sciatica, scoliosis, spondylolisthesis, stenosis, and others. There are many advantages to endoscopic spine surgery, but it is not a replacement for all spine surgeries.
Can it help everyone?
Not everyone can be treated with endoscopic spine surgery. Certain conditions still require a minimally-invasive open approach. Endoscopic spine surgery is the next advancement in the treatment of spinal disorders.
Why isn’t all spine surgery done this way?
These procedures require a unique combination of skills that take time to acquire and most insurance companies do not cover the full cost of the instruments necessary to perform the procedure.