What is Endoscopic Spine Surgery
“Endoscopic spine surgery is a departure from the traditional approach to spine surgery,” according to Dr. Peter Derman, a fellowship-trained spine surgeon on the medical staff of Texas Health Center for Diagnostics & Surgery. “It involves inserting a camera in through the skin via approximately an eight millimeter incision, smaller than a dime. The camera is directed down to the spine where the surgeon can directly visualize and repair the problem using a series of micro instruments.”
Endoscopic surgical techniques can be used to relieve pain, numbness, tingling and/or weakness in the arms or legs caused by pinched nerves within the spine.
“We use this approach mostly with patients who have compression of their nerves, whether that's from a disc herniation or arthritis and bone spurs,” said Dr. Derman. “It's a tool that can be used to decompress or take pressure off of nerves.”
Open Spine Surgery vs. Ultra-Minimally Invasive Spine Surgery?
Compared to traditional open spine surgery, ultra-minimally invasive endoscopic spine surgery techniques minimize the damage to muscles and tissues while still allowing the surgeon to gain access to the spine. This makes for a smaller incision, less bleeding, minimal scaring, and rapid recovery.
“There's a whole spectrum of surgical techniques. These range from traditional spine surgery, which involve an open incision and removing the soft tissues in order to directly see the spine, to minimally invasive techniques, which involve less muscle damage, but still require an open incision,” said Dr. Derman. “The next iteration is endoscopic surgery, or ultra-minimally invasive surgery, which uses a camera through an extremely small incision. By making that leap to using a camera, rather than looking with your eyes or looking with a microscope, it allows for even smaller incisions, less tissue damage and quicker recovery.”
Advantages and Risks of Endoscopic Spine Surgery
Is endoscopic spine surgery safe? It’s important to note that all surgical procedures involve some degree of risk, but endoscopic procedures can be performed safely and reliably in experienced hands.
Endoscopic spine surgery offers several key advantages over traditional surgery. Research shows tissue trauma is significantly reduced with endoscopic techniques. Because endoscopic surgery is friendlier to the tissues around the spine, patients enjoy a much shorter recovery time.
“After you remove the camera at the end of the procedure, the patients get a stitch under the skin, a glorified band-aid, and go home the same day,” said Dr. Derman. “Very little pain medication is necessary. Many of my patients just take Tylenol; most don’t require any type of narcotics. I had one patient recently who told me she was at the gym on the elliptical less than 24 hours after her spine surgery, which was pretty incredible.”
What is the Success Rate for Endoscopic Spine Surgery?
Endoscopic spine surgery is successful in alleviating sciatic pain in the vast majority of cases. In many cases, this can help patients avoid spinal fusion surgery, a procedure in which adjacent vertebrae are fastened together using screws and other implants. Spinal fusion limits range of motion and places additional stress on adjacent discs, which can lead to the need for additional surgery down the road.
With an endoscopic procedure, patients don't lose any range of motion, and the recovery is much quicker.
“The beauty of endoscopic techniques is that they allow surgeons to access areas of the spine that previously would've required a fusion surgery,” said Dr. Derman. “On multiple occasions now I've done outpatient endoscopic surgeries on people who otherwise would've required a spinal fusion.”
Who is a Candidate for Endoscopic Spine Surgery?
As with other spine surgeries, endoscopic surgery is generally recommended only after the patient has tried nonsurgical treatments – such as physical therapy, injections and/or non-narcotic medications – without relief. If those don’t work, endoscopic spine surgery may be considered as a treatment option for patients with pain in the neck, lower back, arms or legs.
“Endoscopic surgery is basically a tool that can be used in any situation where we need to decompress or take pressure off of nerves to alleviate pain running down the legs or arms,” said Dr. Derman. “So, whether that pressure is due to a disc herniation, or arthritis or bone spurs, endoscopic techniques can be helpful. We have seen great results for everyone from the young patient with a soft disc herniation, to the older patient with arthritis or degenerative disc disease. All these issues may be addressed with endoscopic techniques.”