Endoscopic Spine Surgery

Endoscopic spine surgery involves use of an endoscope to visualize the disc and inside of the spinal canal. Endoscope provides a magnified and well illuminated view on a big TV screen. Long, narrow instruments are passed through the endoscope to perform required surgery inside. Endoscopic discectomy is most commonly done procedure; however, endoscopic spinal stenosis decompression and endoscopic spine fusion surgeries are also done. Many of these surgeries can be done under local anesthesia and as day care procedure. Endoscopic spine surgeries provide all benefits of minimally invasive spine surgery.

Types of Endoscopic Spine Surgeries:

1. Endoscopic Discectomy: Lumbar disc herniation is most common indication of endoscopic spine surgery. Endoscopic discectomy involves removing only the herniated part of the disc. It can be done as 1) Trans-foraminal endoscopic discectomy or 2) Interlaminar endoscopic discectomy, depending upon location of herniated disc and surgeon’s preference.
2. Endoscopic Spine Decompression: Lumbar spinal stenosis can be decompressed using a wider endoscope and removing tissue causing pressure on spinal cord (ligamentum flavum, overgrown fact joints, herniated disc).
3. Endoscopic Lumbar Fusion: A complete endoscopic discectomy is performed. Bone graft and cage are inserted in intervertebral space using a small tube under fluoroscopy guidance. Percutaneous pedicle screws are then inserted using small holes in skin.
4. Posterior Cervical Endoscopic Discectomy: A smaller endoscope is used to remove herniated part of cervical disc from posterior micro-foraminotomy approach. This avoids anterior complete discectomy which then requires a fusion procedure. Only laterally herniated discs are treatable by endoscopic micro-foraminotomy.
5. Endoscopic Disc Debridement: Infective discitis caused by bacteria or tuberculosis can be debrided with the help of spine endoscope. This reduces pain and also provide tissue for further testing.

Various other procedures like anterior cervical discectomy and procedures on thoracic spine can also be performed with the help of spine endoscope.  Endoscope can be used to visualize front part of spinal cord to confirm adequate anterior decompression by posterior approach.

Advantages of Endoscopic Spine Surgery:

• These are most minimally invasive spine surgeries with all the advantages of an MIS spine surgery.
• Many procedures can be done under local anesthesia hence suitable for older patients with medical problems.
• These are very safe procedures due to magnification and illumination provided by endoscope.

Disadvantages/ Limitations of Endoscopic spine Surgery:

• Specialized training is required.
• Specialized OT setup and equipment are required.
• Surgeries are slightly costlier due to use of specialized instruments.
• Sometimes, an adequate decompression is not achieved by endoscopic procedure.
• Not all pathologies are treatable by endoscopic techniques.