Endoscopic spine surgery is a procedure that uses an endoscope – a small camera similar to the devices used 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 gastrointestinal surgery. In recent years, advances in optics, surgical instruments, and other supporting technologies make this surgical treatment an option for back 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,” says Dr. Peter Derman, a spine surgeon on the medical staff at Texas Health Center for Diagnostics & Surgery. “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.”

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 causes damage to the muscles and other surrounding soft tissues due to movement. Patients often experience more 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,” says 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. Some of the conditions that endoscopic spine surgery can treat are:

• Sciatica
• Herniated or bulging discs
• Spinal stenosis

“This technique is most effective for people who have compression of their nerves,” says 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.”

For patients who might have been advised to undergo spinal fusion surgery, endoscopic spine surgery can offer an alternative solution. 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,” explains 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.

“Most patients go home the same day after surgery,” Dr. Derman says. “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.”

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.

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.

A spine surgeon on the medical staff at a Texas Health hospital can help weigh the potential advantages and disadvantages of your surgical options and determine the most appropriate care approach for you.

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