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What is Endoscopic Spine Surgery?

In simple terms, endoscopic spine surgery is a minimally invasive spinal procedure that uses micro incisions as well as specialized visualization and surgical tools to treat a wide variety of spinal conditions.

This cutting-edge technique is used at the affected portion of the spine with minimal muscle and tissue disruption. A small camera, known as an endoscope, allows the surgeon to view what they’re doing without opening up large portions of the back.

Why is Endoscopic Spine Surgery Groundbreaking?

Endoscopic spine surgery is a minimally invasive spine surgery meaning that there is less disruption to the muscles, nerves and soft tissues that surround the spine. Additionally, it boasts greater surgical accuracy which lends itself to a safer operation and speeds up recovery dramatically.

The average incision size for a minimally invasive surgery is around 1 inch. In contrast, open spine surgery generally requires a 6-inch incision–a dramatic difference.

However, one of the primary benefits of minimally invasive spine surgery is also one of its largest drawbacks. In these procedures, surgeons are required to work through a very small opening and have almost no ability to see where they’re working with their naked eyes. In the past, they’ve used fluoroscopes as well as large, bulky microscopes to visualize the spine. While these solutions are suitable for a trained surgeon, they don’t always provide great views of the spine and can, depending on the location of the affected area, force the physician to work in an awkward position.

An endoscope is a thin, flexible tube with a light and a camera attached to the end. It’s an instrument pretty commonly used in the healthcare industry to give physicians a high-resolution look at internal organs and structures.

The first endoscope was invented in the early 1800s by a man named Philipp Bozzini. However, it wasn’t until the mid-1900s, when fiber optics were first being pioneered, that endoscopes really started to become a practical and powerful tool in the operating room.

Originally, endoscopes were designed for exploring areas of high risk such as the throat, lungs, stomach and intestines. While they’re still used in this way today, they’ve also found a critical place in minimally invasive surgical procedures.

In the field of orthopedics, surgeons have been using endoscopes to treat damage in the knees and shoulders without exposing the entire joint. However, implementation in the field of neurosurgery has been rather slow because working around critical structures of the spine requires an unparalleled degree of accuracy.

Recent advances in visual technology and the creation of specialized tools are now allowing highly-trained neurosurgeons to safely integrate the benefits of endoscopy into the field of minimally invasive spine surgery.

Summary

Endoscopic spine surgery is groundbreaking because it requires a much smaller incision while still giving neurosurgeons the ability to see everything clearly. This increases accuracy and speeds up recovery.

HOW DOES ENDOSCOPIC SPINE SURGERY WORK?

In an endoscopic spine surgery, a surgeon will make a small keyhole incision in the back, often about 7mm, and place a specialized endoscope down to the affected area of the spine.

This endoscope is an instrument specially created for spine surgery, giving enough room for a high definition camera and light source as well as a working channel for the neurosurgeon’s instruments and an irrigation channel.

This gives the surgeon everything they need to perform their operation safely and effectively without having to open up a large section of the back.

Unlike open spine surgery, which requires surgeons to scale or cut through muscles and soft tissue when accessing the spine, neurosurgeons simply need to push the soft tissues aside when traveling down to the affected portion of the spine. This gentle approach is safer and causes far less post-operative pain.

Once the endoscope has reached the affected portion of the spine, the neurosurgeon is able to run specialized tools down through the tube and shave, clip or extract the damaged portions of the disc or spine that are pressing up against the nerves.

In terms of visualization, the endoscope is second to none. With the high definition camera and a powerful light source, physicians are able to see exactly where they’re working and what’s occurring in the back at all times.

The endoscopic camera is connected to a monitor that sits in front of the operating surgeon which he watches while performing the procedure. This is, undoubtedly, one of the most technical parts of the operation because the neurosurgeon must work with their hands while watching a screen.

Being able to do this with the level of precision required for spine surgery takes years of specialized training.

Below is a real-life example of what a neurosurgeon sees while performing an endoscopic spine surgery.