Spine surgery today is advancing constantly thanks to new, minimally invasive techniques. The goal of these techniques is to decrease the possibility of complications during surgery and to make recovery easier. In the following article, we explain all about endoscopic spine surgery, what it is, and what its main advantages are.
Endoscopic spine surgery is a minimally invasive surgical alternative to conventional open microdiscectomy. This versatile technique is used to treat disc herniations that compress a nerve root, either inside the canal or outside the foramen, bulges, tears, or degeneration causing spinal stenosis, which are the most frequent causes of low back pain or leg pain and difficulty walking.
It is one of the most innovative surgical techniques to have been developed in recent years. In this procedure, through a small incision in the spine, the surgeon can use an endoscope with a high-definition camera to determine the cause of back and leg pain, and have access to the area to perform the necessary decompression, remodeling of the canal, or hernia extraction.
While endoscopy is generally used for surgery on other areas of the body, new developments in optics, tissue visualization, and spinal imaging techniques, have allowed endoscopic spine surgery to be a surgical treatment option for many patients who could not have spine surgery through conventional methods, such as older adult patients or people who were overweight or obese.
The neurosurgeons who perform endoscopic lumbar spine surgery at Instituto Clavel, are Dr. Varela, Dr. Català, Dr. Santander, and Dr. Zabaleta. Our team uses this operation to relieve pain, avoid spinal fusion surgery, and to preserve as much of the patient’s spinal anatomy as possible, minimizing the need for another surgery in the future.
Advantages of endoscopic spine surgery
Microdiscectomy is the surgical technique conventionally used for treating some types of herniated disc. It requires an incision, and the damaged tissue is removed from the lumbar disc with the aid of a special microscope. Until recently, this was the surgical procedure of choice for treating disc herniations.
Several studies and reviews suggest that endoscopic lumbar surgery will soon become the procedure of choice for performing discectomies as it offers a series of advantages over conventional surgery:
- Because it involves less tissue manipulation and damage, there is less postoperative pain.
- Because it is less painful, there is almost no need for anti-inflammatories or narcotic medication.
- Recovery is faster, so the patient can return to work and their normal life sooner. As of today, it is the preferred choice of surgery for competitive athletes.
- The time under anesthesia is shorter compared to open and instrumented surgery. This is an advantage for elderly patients or people with sensitivity to anesthetics.
- The incision is less than 1cm, which decreases the risk of infection, and the wound healing is optimal.
- There is minimal bleeding.
- The risk of a cerebrospinal fluid (CSF) fistula drops dramatically.
- Thanks to the fact that, in many cases, it is not necessary to resection the bone to reach the hernia, so it is less likely to cause instability.
- The side effects of this spine surgery are usually mild and go away on their own within a few days. The most common side effects are pain, swelling and bruising at the incision site.
When is endoscopic lumbar surgery used?
Most patients who are candidates for endoscopic spine surgery have previously been diagnosed with common types of spinal disorders. This type of operation is indicated for certain types of lumbar pathologies:
- Foraminal disc herniation
- Extraforaminal disc herniation
- Posterolateral or medial disc herniation
- Foraminal stenosis
- Central canal stenosis
On the other hand, this surgical technique is not recommended in the case of very bulky or migrated, calcified, or moderate-to-severe spondylolisthesis herniations.
How is endoscopic spine surgery performed?
To perform endoscopic lumbar discectomy, an incision of about 5-8 mm is made in the skin. Using fluoroscopic guidance, the surgeon inserts a cannula through the incision to reach the vertebral disc, either through the neural foramen (in foraminal or extraforaminal herniations), or through the interlaminar space (in posterolateral or medial herniations), depending on where the hernia to be treated is located.
The endoscopic camera is then inserted in the cannula, which allows the spine surgeon to see the expanded field of work on a screen, and also the various instruments which will be used to perform the extraction of the herniated fragment and the decompression of the nerve.
During the intervention, the tissues are continuously irrigated through the cannula, which makes it possible to contain or stop possible hemorrhages, perform hydrodissection of tissues, and separate structures.
As in conventional surgery, complications and risks are also possible in endoscopic surgery. These may be immediate risks, such as injury to a nerve, abdominal-pelvic structures, or insufficient decompression; early risks, such as dysesthesia, bruising, infection or CSF fistula; and late risks, such as re-herniation or instability of the level that has been operated on. But in general, all these risks and complications are much lower in endoscopic surgery compared to traditional open surgery.
Recovery after endoscopic spine surgery
As we said in the section on the advantages, using the endoscopic technique offers a faster recovery time compared to other conventional surgeries, because it is a minimally invasive spine procedure. Some patients can walk the same day after the operation and, in most cases, the patient can be discharged within 24 hours.
Recovery time is generally around 3 to 6 weeks. Major rehabilitation is often not necessary because endoscopic spine surgery requires only minimal manipulation of bone tissues and structures. In any case, our team at Instituto Clavel Rehabilitation is available to indicate the most appropriate plan for the individual patient.
Categories: Spine treatments, Spine pathologies, Surgery