What is Endoscopic Spine Surgery?

The last several years have seen great strides in developing advanced surgical solutions for spinal problems. Many of these advances involve minimally invasive procedures that leave surrounding tissue undisturbed, allowing faster recovery times and eliminating many of the complications associated with invasive back surgery operations. 

Minimally invasive spine surgery is taken one step further by state-of-the-art miniaturized medical equipment, such as fiber optic cameras and microscopes. These procedures, often referred to as endoscopic spine surgery, lend themselves to treating a variety of spinal conditions and disorders including slipped disc and pinched nerves.

These minimally invasive spine surgery procedures can remove tissue exerting pressure on nerve roots emanating from the spine, providing dramatic relief for back pain and restricted mobility. However, like any form of surgery, endoscopic spine surgery should be performed only if non-surgical treatment options have been exhausted and these restricted access techniques can adequately address the patients’ diseases.

What Is Endoscopic Surgery?

Endoscopic surgery is defined as a surgical procedure that allows the surgeon to view the inside of the body using minimally invasive techniques. 

This surgical approach earned its name from the endoscope, which is a medical device devised of a long, thin tube, a light, and, often, a very small video camera at the tip. The endoscope can be inserted through a small incision (smaller than the incisions used in conventional spinal surgery) to provide a view of the spine. By using an endoscope, surgeons can precisely view and operate on the spinal structures without having to cut through the back muscles or significantly disrupt other tissues. 

Endoscopic surgery is a treatment option for chronic back pain, radiating pain, numbness, tingling, and weakness from various spinal conditions, including:

Is Endoscopic Spine Surgery the Same as Minimally Invasive Spine Surgery?

Endoscopic spine surgery is a type of minimally invasive spine surgery. All endoscopic spine surgeries are minimally invasive, but not all minimally invasive spine surgeries are endoscopic. 

The key difference between endoscopic spine surgery and other minimally invasive spinal procedures is, of course, the endoscope. With a small camera, the endoscope delivers high-definition imaging through a very small incision, providing surgeons with excellent magnification and a clear view of the spinal structures. 

Endoscopic spine surgery is considered minimally invasive because it dramatically reduces the size of the incision required to access the spine. This may be referred to as a “keyhole” incision and, for reference, is generally less than one-quarter of an inch. This is far smaller than conventional open surgery, which requires an incision of at least three inches. Remarkably, it’s even smaller than other forms of minimally invasive spine surgery, which require an incision of at least one inch. 

Along with this smaller incision, endoscopic spine surgery facilitates less tissue trauma than conventional spinal surgery and other minimally invasive spine surgery techniques. This leads to less postoperative discomfort, faster recovery periods, less blood loss, and lower infection rates. 

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What Is the Difference Between Microdiscectomy and Endoscopic Spine Surgery?

The difference between microdiscectomy and endoscopic spine surgery is that microdiscectomy requires a larger incision and often involves removing bone tissue to access the damaged spinal disc. 

In contrast, endoscopic spine surgery typically allows the surgeon to access the damaged disc through the neuroforamen, a natural opening in the spine. So, while microdiscectomy is still considered a minimally invasive procedure, it involves more tissue damage and requires a longer recovery than endoscopic spine surgery. 

Here are a few other key differences between microdiscectomy and endoscopic spine surgery:

  • In endoscopic spine surgery, the camera on the end of the endoscope grants the surgeon excellent visualization of the treatment area. 
  • Endoscopic spine surgery allows the surgeon to make the incision to one side of the spine, while the incision in microdiscectomy is made directly over the targeted disc. 
  • Endoscopic spine surgery may not require general anesthesia due to the limited incision. Microdiscectomy usually requires the patient to be under general anesthesia, which comes with its own risks and possible complications, like:
    • Allergic reactions to anesthesia
    • Confusion 
    • Sore throat
    • Anesthesia awareness
    • Breathing issues 
    • Malignant hyperthermia, a severe and dangerous reaction to anesthesia
  • Microdiscectomy often requires the surgeon to move the back muscles to the side to access the spine. This necessitates more tissue recovery and causes more post-operative pain than endoscopic spine surgery. 

When to Do Endoscopic Spine Surgery

Endoscopic spine surgery should be done when:

  • The patient has chronic back pain and neurological symptoms from a condition like herniated disc, spinal stenosis, spondylolisthesis, or osteoarthritis. 
  • The patient’s symptoms haven’t improved despite several months or years of conservative treatment. Conservative treatments include physical therapy, epidural injections, and medication to control pain and discomfort. 
  • The patient’s symptoms are disruptive to their daily activities and/or diminish their quality of life. 
  • The patient is considered a candidate for endoscopic spine surgery. 

Since endoscopic surgery provides several benefits over conventional spine surgery and even other minimally invasive procedures, it should be utilized whenever possible for qualifying patients. 

Who Is a Candidate for Endoscopic Spine Surgery?

You may be a candidate for endoscopic spine surgery if you:

  • Have a spinal condition causing chronic, progressive pain and neurological symptoms
  • Haven’t resolved your symptoms with conservative treatments
  • Are interested in reducing your downtime and surgical risks with the endoscopic procedure

You may not be a candidate for endoscopic spine surgery if you:

  • Have a particularly complex spinal condition, like some cases of spinal cancer and scoliosis, as these may require a different surgical procedure
  • Need or want to undergo spinal fusion
  • Have undergone one or more spinal procedures in the past, as this can cause scar tissue in the spine that may interfere with endoscopic spine surgery
  • Are a smoker, as smoking can inhibit your body’s healing process (quitting smoking before the procedure may amend this issue)
  • Have certain underlying medical conditions that could present risks in the endoscopic procedure

Your physician will conduct a thorough medical exam, questionnaire, and imaging tests to determine if you’re a good candidate for endoscopic spine surgery. 

How Long Does It Take to Recover From Endoscopic Spine Surgery?

It typically takes one to four weeks to recover from endoscopic spine surgery. 

Recovery times vary somewhat from patient to patient, but most people return to work, driving, and gentle exercise around two weeks after the procedure. Additionally, a hospital stay generally isn’t needed after endoscopic spine surgery, so you can return home as soon as you feel able. Just make sure to have someone drive you home on the day of the procedure. 

During the first week after endoscopic spine surgery, you’ll need to avoid twisting and bending the spine. You also can’t lift heavy objects during this period, so plan accordingly.

You can speed up your recovery from endoscopic spine surgery by:

  • Following all of your surgeon’s post-operative instructions
  • Avoiding prolonged bed rest (stay mobile with gentle, low-impact movements, like short walks)
  • Eating a nutrient-rich, anti-inflammatory diet
  • Avoiding any activities or movements that trigger pain
  • Prepping your home before the procedure to facilitate rest and healing
  • Prioritizing high-quality sleep

Deciding If Endoscopic Spine Surgery is Right For You

If you and your physician conclude that endoscopic back surgery may be appropriate, the decision on which procedure is best should be made only after a thorough evaluation of all aspects of your case. In some situations where bone must be removed from a vertebra as part of the surgical procedure (as in a laminectomy or spinal decompression surgery procedure), the endoscopic procedure does not provide adequate access or visualization to perform a proper decompression.

Suboptimal removal of pain generators, especially when followed by the fusion of adjacent vertebrae, can have adverse outcomes. Moreover, it is irreversible as spine fusion surgery eliminates the independent flexion and rotation of the fused vertebrae. But another advance of recent years, the TOPS™ System, has proven to provide a better clinical outcome than spinal fusion. An implant device, the TOPS, or Total Posterior Solution System, preserves the independent motion of the individual vertebrae.

If you suffer from back pain or other symptoms of spinal problems, don’t let outdated ideas about back surgery keep you from seeking treatment. Today a host of conservative treatments such as medication and physical therapy can often provide relief, and when surgery is called for, it can often be performed without complications.