Endoscopic Spine Surgery

What is Endoscopic Surgery?

Endoscopic Spine Surgery is extreme minimally invasive spine surgery used in the treatment of back pain, leg pain, numbness and weakness, bone spurs, bulging discs, stenosis, herniated disc, facet joint disease, sciatica, scoliosis, spondylolisthesis and more.

It is spine surgery with a skin incision less than 1-inch, but it is more than just a small incision. The surgery is done through a tube in 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.

Surgical Endoscope

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 to remove a disk herniation, bone spurs, thickened ligament and cut dorsal medial branch nerves under direct view. Most patients will have immediate pain relief.

For example, a herniated disk pinches the nerve causing back and leg pain called sciatica. This burning, stabbing pain can be very debilitating to the person. During a 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 (MISS). Bone and ligament are then cut away to expose the nerves increasing 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. Very 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 which improves recovery.

How is endoscopic laser spine surgery different then 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 more destructive in its approach to the spine for the problem being treated. The larger the incision the more damage to muscle, ligaments and bone. This collateral tissue damage may result in more pain, back muscle weakness (erector spinae), instability and scar tissue leading to future difficulties.

Endoscopic spine surgery is extremely minimally invasive, even for minimally invasive spine surgery. 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 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 disc, facet joint disease, sciatica, scoliosis, spondylolisthesis, stenosis and others. Due to the many advantages of endoscopic spine surgery it should be always considered, but currently it is not a replacement for all spine surgeries. The indications are rapidly increasing with the advancement of surgical techniques and equipment.

Why can it help people others surgeries cannot?

Traditional surgery is limited because the surgeon requires 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. This greater visualization combined with less damage and surgical risk increases the spectrum of pathology that can be treated safely. This allows treatment of spinal disorders traditional surgery may not be able to treat without also performing a fusion.

Can it help everyone?

Not everyone can be helped with endoscopic spine surgery. Certain conditions still require a minimally invasive open approach. Endoscopic spine surgery is the next advance in the treatment of spinal disorders.

Why is not all spine surgery done this way?

These procedures require a unique combination of skills that take time to acquire. The other problem is that most insurance companies do not cover the full cost of the instruments necessary to perform the procedure. For this reason out of pocket costs are possible but my opinion is that the costs are minimal compared to the benefits and if I needed to have surgery on my back again then I would have endoscopic spine surgery performed.