“Endoscopic spine surgery is a departure from the traditional way that spine surgery is performed,” said Dr. Peter Derman, a spine surgeon on the medical staff of Texas Health Center for Diagnostics & Surgery. “This type of surgery involves inserting a camera through the skin via an incision smaller than a dime. The surgeon can see the spine from within and remove pressure from pinched nerves using a series of micro-instruments. Once this is complete, patients get a stitch under the skin, a glorified Band-Aid, and are comfortably home within hours, often with immediate and dramatic improvement in their symptoms.”
Physicians may recommend lumbar endoscopic spine surgery for a number of different spinal conditions affecting the lower back, also called the lumbar spine.
Here are some basics to help determine whether you might be a candidate for endoscopic spine surgery.
Endoscopic Spine Surgery: What is it?
Endoscopic spine surgery is the “next wave” in spine surgery.
“There's a whole spectrum of surgical techniques, from traditional spine surgery, which involves an open incision, to minimally invasive techniques, which involve smaller but still open incisions,” said Dr. Derman. “The next iteration is endoscopic spine surgery – also called ultra-minimally invasive spine surgery. Making that leap to using an internal camera, rather than opening the body and looking with your eyes or a microscope, allows for even smaller incisions, less tissue damage, and quicker recovery.”
By definition, endoscopic spine surgery is a procedure that uses an endoscope – a small camera similar to the devices employed in shoulder or knee arthroscopy surgery – to reach problem areas in the spine. Similar surgical approaches have been used for some time to treat other areas of the body (such as in gastrointestinal surgery). In recent years, advances in optics, surgical instruments, and other supporting technologies make this surgical treatment an option for back surgery.
Endoscopic spine surgery differs from traditional open surgery. With traditional methods, the surgeon makes a sizable incision, then detaches and moves the underlying muscles out of the way to access the spine and address the problem at hand. The biggest drawback of open surgery is that this process damages the muscles and other surrounding soft tissues. Patients often experience significant surgical pain after such operations, which differs from their original pain and can prolong the recovery period. There is also increased blood loss and higher infection rates.
By contrast, endoscopic spine surgery helps avoid many of those drawbacks.
“Rather than opening up the body to see the spine and fix the problem, endoscopic surgery involves inserting a camera down to the spine via a tiny incision. The surgeon can then directly visualize the problem from within the body and correct it using a series of micro-instruments,” said Dr. Derman.
What Conditions Can Be Treated with Endoscopic Spine Surgery?
Endoscopic spine surgery may be performed for a wide variety of problems affecting the lower back.
“This technique is most effective for people who have compression of their nerves,” said Dr. Derman. “Whether that's from a disc herniation or arthritis and bone spurs, it's really a tool that can be used to decompress or take pressure off the nerves.” Decompression involves removing bone spurs, overgrown soft tissues, or a herniated discs.
Some of the conditions that endoscopic spine surgery can treat:
Sciatica. Sciatica refers to pain radiating along the sciatic nerve, which runs from the lower back through the hips and buttocks and along each leg. Typically, sciatica affects only one side of the body. Sciatica most commonly occurs when a herniated disc or bone spur causes narrowing of the spinal canal (spinal stenosis) which compresses part of the spinal nerve. This causes pain, inflammation, and sometimes numbness in the affected leg. “Sciatica is pain running down the leg caused by pressure on the nerves, and it can be seen in young and old alike,” said Dr. Derman.
Herniated or bulging discs. Each spinal disc has a soft, gel-like center encased in a tougher, rubbery exterior, or annulus. A herniated disc can occur when the inner part of one of the soft cushions (discs) that sit between the bones (vertebrae) of the spine pushes through the exterior of the disc, putting pressure on a nearby nerve. Sometimes called a slipped disc or a ruptured disc, a herniated disc may occur in any part of the spine, but most often affects the lower back or neck. Depending on where the herniated disc is located, it can result in pain, numbness, or weakness in an arm or leg.
Spinal stenosis. Spinal stenosis is a narrowing of the spaces within the spinal canal, creating pressure on the nerves that travel through the spine canal and can lead to leg or buttock pain, heaviness, fatigue, numbness or weakness. Patients with spinal stenosis often have difficulty walking distances and have to sit or lean forward frequently to “recharge” their legs.
For patients who might have been advised to undergo fusion surgery, endoscopic spine surgery can offer an alternative. Spinal fusion surgery permanently connects two or more vertebrae in the spine, eliminating motion between them. This technique can be effective in treating conditions due to spinal instability – but also requires longer recovery, results in limited range of motion in the area that is fused, and may precipitate a domino effect of needing additional surgery at other spinal levels down the line.
“Endoscopic techniques allow surgeons to access areas of the spine that previously would've required a fusion surgery,” said Dr. Derman. “On multiple occasions, I've done outpatient, endoscopic, non-fusion surgeries on people who otherwise would've required a fusion. The problem with fusion is it takes longer, oftentimes involves a more protracted recovery and eliminates motion at that level. The beauty of an endoscopic decompression, which is not fusion, is that patients get up, they get moving and they don't lose any of the motion that they had.”
What Does Recovery Involve After Lumbar Endoscopic Spine Surgery?
Endoscopic spine surgery is typically performed on an outpatient basis, which means that no overnight hospital stay is required.
The procedure typically takes about an hour, with the patient under general anesthesia or even just sedation.
Many patients who opt for endoscopic spine surgery are typically pleasantly surprised by the ease of recovery following surgery.
“Most patients go home the same day after surgery,” Dr. Derman said. “Very little pain medication is necessary; in fact, I often have patients who just take Tylenol or even nothing at all after surgery. Patients can be active as soon as they feel comfortable doing so. I'm totally okay with them walking, using the elliptical, or riding a stationary bike without limitation as soon as they feel comfortable. 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 is pretty incredible.”
Is Lumbar Endoscopic Spine Surgery Right for You?
In most cases, spine surgery is recommended only if nonsurgical treatments – such as non-narcotic medications and physical therapy – have not relieved the painful symptoms caused by the back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of the pain, such as a herniated disc or spinal stenosis.
As with any operation, there are potential risks associated with endoscopic spine surgery. These risks may include bleeding, infection, recurrence of the original symptoms, blood clots, and very rarely, nerve damage.
Keep in mind that endoscopic techniques are not appropriate for all types of spine problems. Surgery for scoliosis, spinal instability, cancer, or trauma may require traditional open surgery or another minimally invasive spine procedure.
Before your surgery, discuss these risks with your doctor, who can help you weigh the potential advantages and disadvantages of your surgical options.