Endoscopic Spine Surgery

This article will explore the development of endoscopic spine surgery, the techniques employed, and the benefits and risks associated with this revolutionary approach. Additionally, we will provide evidence supporting its safety and efficacy.

A Brief History of Endoscopic Spine Surgery

The concept of endoscopic surgery has its roots in the early 20th century when physicians began to explore the use of rigid endoscopes for diagnostic and therapeutic purposes.

Over time, advancements in optics, video technology, and surgical instruments led to the development of minimally invasive surgical techniques. In the late 20th century, these advancements were adapted for spinal surgery, leading to the development of endoscopic spine surgery. The evolution of this surgical approach has resulted in more precise, less traumatic procedures with faster recovery times and improved patient outcomes.

Endoscopic spine surgery procedures can be classified based on the approach used to access the spine and the specific spinal condition being treated. The main categories include transforaminal and interlaminar.

1. Transforaminal Endoscopic Spine Surgery

The endoscope is directed through the spinal nerve exit tunnel of the neuroforamen.

• Transforaminal Endoscopic Discectomy: This procedure is performed to remove herniated disc material that is causing nerve compression and pain. The surgeon accesses the disc space through a small incision in the skin and uses an endoscope to visualise the area. Specialised instruments are used to remove the herniated disc material while preserving the surrounding structures.
• Transforaminal Endoscopic Foraminotomy: This technique treats foraminal stenosis or narrowing of the spinal nerve exit, which causes nerve compression.
  The surgeon accesses the foramen using an endoscope and specialised instruments to remove bone spurs, ligaments, or disc material, thereby decompressing the nerve.

2. Interlaminar Endoscopic Spine Surgery

The endoscope is passed between the bony rings of the spine or lamina, the same point of access as traditional surgery but with a much smaller incision being required

• Interlaminar Endoscopic Discectomy: Similar to the transforaminal approach, this procedure removes herniated disc material causing nerve compression. However, the interlaminar approach accesses the spine between the laminae rather than through the foramen.
• Interlaminar Endoscopic Laminotomy: This technique is employed to treat spinal stenosis caused by overgrowth of bone and soft tissue. The surgeon removes a portion of the lamina to decompress the spinal canal and relieve pressure on the nerves.
• Interlaminar Endoscopic Decompression for Central Stenosis: This procedure addresses central spinal stenosis by removing the thickened ligamentum flavum, bone spurs, and other structures causing compression. The surgeon uses an endoscope to visualize the area and specialized instruments to perform the decompression.

Advantages Of Endoscopic Spine Surgery

There are several advantages of endoscopic spine surgery compared to conventional open spine surgery:

• Smaller incisions: Endoscopic spine surgery involves making smaller incisions compared to traditional open surgery. This results in less damage to the surrounding muscles and tissues, which can help reduce postoperative pain and recovery time.
• Reduced blood loss: Endoscopic spine surgery generally involves fewer incisions and tissue disruptions, which results in less blood loss. This can lower the risk of complications related to blood loss and the need for blood transfusions.
• Decreased risk of infection: Smaller incisions and less tissue exposure can reduce the risk of postoperative infection, as there is less opportunity for bacteria to enter the surgical site.
• Faster recovery: Due to the minimally invasive nature of endoscopic spine surgery, patients often experience shorter hospital stays, reduced postoperative pain, and faster return to daily activities compared to traditional open spine surgery.
• Less scarring: Smaller incisions result in less visible scarring, which can be a significant cosmetic benefit for patients.
• Preservation of spinal mobility: Endoscopic spine surgery allows for targeted treatment of spinal problems with minimal disruption to surrounding structures. This can help maintain spinal stability and mobility, which can be compromised in more invasive surgical procedures.
• Lower risk of adjacent segment disease: By minimising disruption to surrounding structures, endoscopic spine surgery may lower the risk of adjacent segment disease, a condition in which adjacent spinal levels degenerate after spinal surgery.

Risks of Endoscopic Spine Surgery

As with any surgical procedure, endoscopic spine surgery carries some risks, including infection, bleeding, nerve damage, and anesthesia-related complications. However, these risks are generally lower than those associated with traditional open spinal surgery.

Evidence Supporting Endoscopic Spine Surgery

Numerous studies have demonstrated the safety and efficacy of endoscopic spine surgery.

For example, a study published in the World Neurosurgery journal in 2016 found that endoscopic transforaminal discectomy led to significant improvements in pain and a low rate of complications (1).

Another study published in the Journal of Spine Surgery in 2018 demonstrated the effectiveness of endoscopic interlaminar discectomy in treating lumbar disc herniation, with 91.9% of patients reporting excellent or good outcomes (2).

A systematic review published in the Global Spine Journal in 2017 analysed 16 studies focusing on endoscopic spine surgery and found that these procedures were associated with high success rates, low complication rates, and reduced hospital stays compared to traditional open surgery.

Endoscopic spine surgery has revolutionised the field of spinal surgery, offering a minimally invasive alternative to traditional open procedures.

The use of advanced visualisation and instrumentation allows for precise treatment of spinal conditions with reduced tissue damage, lower complication rates, and improved patient outcomes.

As research continues to support the safety and efficacy of endoscopic spine surgery, this innovative approach will likely become the standard of care for many spinal disorders.