Endoscopic Spine Surgery

Endoscopic Spine Surgery

In the early days, conventional spinal surgery was considered to be associated with long incisions, a lot of blood loss, a long stay in the ICU, and a high probability of nerve injury. Thus, patients were anxious and reluctant to go through surgery for treatment of their existing symptoms. However, with the advancement of medical technology in modern days, surgery is much safer and more efficient than in the past, reducing the risk of prolonged bed rest to a very small extent to none. 

Evolution in the Advancement of Spinal Surgery

1.  Open Spine surgery

     The traditional method of treatment that we are familiar with is usually the open spine surgery. Surgeons will make a long incision to fix the position of the spinal cord and release the pressure on the suppressed nerve as well as insert a fixation iron to secure the spinal cord in place. This type of surgery has been in practice for more than 50 years and with continuous improvement in medical tools and materials, the practice is much safer and commonly used in the treatment of spinal diseases until recently. 

2.  Surgery through a microscope

     In recent decades, spinal surgery has begun to advance with the introduction of microscopes. The advantage of using a microscope is that it allows the surgeon to have a clear vision of the target area since a microscope enlarges the image of the surgical spot; thus allowing surgeons to work more accurately and safely than ever before, and can significantly reduce the size of surgical wounds and muscle injuries.

In general, patients would hear the word "Laparoscopic surgery", which mostly means surgery using a microscope. The entry of microscopes also plays a part in the beginning of the evolution of Minimally Invasive Spine Surgery (MISS). Contemporary surgeons tend to emphasize the importance of reducing tissue injuries in surgery and therefore, countless surgical methods have been invented to utilize a microscope in combination with percutaneous surgical techniques such as MIS-TLIF fusion surgery, OLIF, Open Microdiscectomy or Tubular Microdiscectomy (Micro-endo). As a result, spine surgery safety has increased substantially while the bed rest period also has notably been reduced.

3.  Endoscopic surgery

     Spinal surgery has experienced another subsequent evolution during the past decade with the arrival of using an endoscope in spinal surgery. The principle of an endoscope is to insert an instrument into the patient's body for treatment of various conditions which is similar to other surgeons performing laparoscopic cholecystectomy (LC) or endoscopic sinus surgery. A notable advantage of endoscopic surgery is the ability to significantly limit the injury to surrounding tissues in comparison to other methods of surgery because endoscopic surgery requires highly precise identification of the surgical spot; thus, incision on surrounding tissues is not necessary. The surgeon can reduce the size of the incision to only 1-1.5 cm. Therefore, the recovery period is shorter than other types of surgery.   

 Actual examples of incisions with an endoscope

The early stage of endoscopic spine surgery was full of limitations in terms of treatment. Most often, this method is chosen for herniated disc surgery alone.  Nonetheless, with the development of surgical instruments along with the invention of various surgical techniques as well as the increasing expertise of surgeons, currently  endoscopic surgery can be performed on several pathologies, such as :

• Endoscopic lumbar decompression
• Endoscopic cervical/thoracic decompression surgery
• Endo-LIF surgery

Moreover, endoscopic surgery can also be performed to reduce the pain of spinal cancer. However, in some cases where the patient endures suffering from spinal deformities, open spine surgery is still considered necessary.    

Advantages of endoscopic spine surgery

• Small incision
• Less post-surgical pain
• Low risk of infection
• Reduced internal scarring
• Quick recovery, patient can go home within 24 hours.
   

Two types of endoscopic spine surgery

At present, there are two types of instruments commonly used in endoscopic spine surgery.

• Full Endoscopic Surgery – this type of surgery is characterized by a single incision. The surgeon will insert the surgical instrument through the hole of the endoscopic camera. The benefit of this type of surgery involves very little removal of surrounding tissue; however, the drawback is not all hospitals offer this option, and surgeons must be very proficient and familiar with surgical instruments in order to achieve a satisfactory result
• Bi-portal Endoscopic Surgery (UBE/BES) There are two entry points for this type of surgery. In one entry, an endoscopic camera will be inserted while in the other entry, a surgical instrument will be inserted for the operation. The advantage of this type of surgery is the readiness of tools and instruments in many hospitals both in the capital and the provinces, which in turn, lead to satisfactory results of the operation. However, the surgery requires more tissue removal than the full-endoscopic surgery method to create space for the movement of the endoscopic cameras and instruments. Similar to the first method, doctors needed to be proficient and have familiarity with the instrument.

Endoscopic spine surgery procedure 

As a common practice for the treatment of spinal diseases, physicians usually start the procedure with the following steps :

• Performing a thorough inquiry of the patient’s medical history and conducting full-scope physical examination to diagnose the root cause of the disease.  
• Performing various radiological tests such as  X-ray, CT-scan, and  MRI  to confirm the diagnosis and plan the treatment journey. For Minimally Invasive Surgery to achieve a good outcome, an accurate diagnosis is crucial in addition to the surgeon’s expertise. A highly accurate diagnosis would help to provide several options to choose for treatment that reduces injury to surrounding tissues. 
• After an accurate diagnosis, physicians will choose from several treatment options. This ranges from taking medication and physical therapy to reduce symptoms in mild cases to corrective surgery. 
• If surgery is the option, normally in a hospital that is fully equipped with modern technology and instruments, doctors will usually select a treatment method that minimizes the patient's pain and recovers as quickly as possible. However, in case of bone compression, degeneration, or inability to choose such an option, physicians will consider other methods of surgery for each case.
• For Endoscopic spine surgery, the patient is usually able to get up and walk in the daily routine and be able to go home the next day.  
• The physician will make a follow-up appointment to check on the patient’s recovery, as well as to recommend appropriate actions for post-operative care. In general, patients will be able to play sports or carry on normal functions completely within 6 months. 

Ultimately, most spinal diseases are curable using appropriate treatment. Currently, surgical technology has substantially advanced in comparison to the last decades; thus, leading to better outcomes and significantly reducing the risk and side effects of surgery. Therefore, treatment of spinal diseases is considered to be safe and the chance of spinal dissection leaving you bedridden is very low.

However, if herniated disc is left untreated for a long time, it may cause permanent nerve atrophy. At present, there are a variety of treatment options, including the role of an endoscope in spinal surgery. As a result, patients are able to safely recover from the pain more quickly.