Improved Tools Generate Growth in Endoscopic Spine Surgery

By Steve Spencer

Endoscopic spinal surgery has experienced significant growth in usage over the last decade, driven by advances in high-definition visualization, improvements in navigation, and specialized instrumentation. “There’s been a significant advance in the quality of the cameras,” said Hossein Aziz, DO, FAAOS. “With the 4K high-definition cameras, you can see things in amazing detail. The angled optics have come a long way, so you really can see around much better. Even some of the tools that we use have been advanced, all in the name of care and patient safety, too. It’s really amazing the leaps and bounds endoscopy has taken. It’s the ultimate in minimally invasive spine surgery.”

With this procedure, which usually takes 60 to 90 minutes, the surgeon makes a small incision, usually eight to ten millimeters, for the endoscope. The small camera at the end of the endoscope allows the surgeon to have a magnified view of the surgical area, and specialized micro-instruments are passed through the endoscope to perform the intervention, which can range from removing herniated disc material, decompressing nerves, or removing or repairing damaged tissue. The approach depends on where the problem is located. The more common approaches include the transforaminal route (through the side) or the interlaminar route (from the back of the spine).

“The main difference between endoscopic spine surgery and traditional spine surgery is the size of the incision,” Aziz said. “With open spine surgery, you’ve usually have a pretty large incision. So the bigger incision means more pain, more blood loss, and higher risk for complication. You’re cutting through muscle which can be rough for rehab because the muscles have to regenerate. You can also get a lot of spasms afterwards as the muscle reattaches. With endoscopic spine surgery, we use dilators to gently separate the muscles, creating a narrow channel for the endoscope and instruments.”

All of this means a faster recovery, less postoperative pain, and a reduced need for time under general anesthesia. With open spine surgery, the patient could be in the hospital for a few days followed by resuming light activity in six to eight weeks, while a full recovery usually takes six to 12 months. By contrast, endoscopic spinal surgery patients are usually back to their full routine in two to three weeks, and can engage in higher-impact activities like heavy lifting or strenuous sports in around seven weeks.

“Rehabilitation strategies vary according to the patient,” Aziz said. “It depends on what the problem is. It could be something as simple as a home stretching program or exercise program, or something more involved like regular physical therapy with a specialist.

“Complication rates are very, very low. Several studies have shown good outcomes in anywhere from 85 to 95 percent of the cases. I’d say the best candidates for this are people who have tried conservative treatment. They’ve tried physical therapy, they’ve tried some medications, but they’re having pain that interferes with their daily life, pain that maybe keeps them from work, that just interferes with normal life.