A single cut suffices for endoscopic spine surgery

Endoscopic spine surgery allows the surgeon to minimise damage to the surrounding tissues, reduce the risk of infection and lessen blood loss, compared to open surgery. — Dr NG BING WUI

Medical advancements have revolutionised the field of spine surgery, offering safer and more effective options for individuals facing various spinal conditions.

Among these groundbreaking developments, endoscopic spine surgery has emerged as an option for patients seeking relief from ailments such as herniated discs, spinal stenosis and degenerative disc disease.

This minimally-invasive technique caters to a diverse range of individuals, from the young to the elderly.

It allows intricate procedures to be performed on the spine through a single small incision with the aid of high-definition visualisation and continuous irrigation.

This is achieved by using an endoscope and a small tubular system inserted through the incision.

The endoscope, which is a thin tube with a light and camera at the tip, enables the surgeon to have a better view and more precision while navigating the spine.

By providing clearer vision of the complex spinal anatomy, the surgeon can perform the necessary procedures while minimising damage to the surrounding muscles, ligaments and tissues.

Endoscopy was originally used to aid in the visualisation of anatomical structures during open surgery in the early 1980s.

Due to the mobility of the endoscope and obstruction of anatomical structures to certain areas in our body, newer techniques were developed for better visualisation and safer surgery.

Advancements in this technique have enabled multiple levels of decompression of adjacent spinal levels to be done through a single incision.

How is it done?

Endoscopic spine surgery is done with the patient lying face down.

The surgeon will make an eight to 10 millimetre incision near the midline of the spine.

A blunt dilator is then used to move the back muscles apart to enable the working sleeve and endoscope to be inserted.

All work on the bones and decompression will be done through the same incision to avoid further tissue injuries.

The procedure creates space for nerve decompression with minimal effects on the facet joints (the connections between the bones of the spine, which the nerve roots pass through).

These are all done on a radiolucent imaging operating table that allows good images to be taken to help the surgeon identify anatomical landmarks.

A radiolucent operating table is one that is transparent to radiation, including X-rays.

A bipolar radiofrequency electro-coagulator is used to stop bleeding, while a high-definition camera endoscope and light source is used to visualise the surgical field (i.e. the area to be operated on).

The most common spinal conditions that could benefit from endoscopic spine surgery are lumbar disc herniation and lumbar spinal stenosis.

Symptoms for these conditions include pain radiating down the leg; pain radiating from the lower back to the leg(s); numbness and weakness of knees, ankle or toes; claudication pain (pain that occurs in the limbs during movement); and severe back pain.

Patients suffering from cervical disc herniation, cervical radicular pain or thoracic ossified yellow ligament can also consider this surgical method as an option.

Advantages of the technique

There are many benefits to endoscopic spine surgery due to its reduced invasiveness and better imagery.

Minimal invasiveness causes less tissue damage, less blood loss and lower risk of infection, compared to open surgery.

This directly results in reduced post-operative pain and faster recovery times.

It also causes minimal scarring as the incision made is around eight to 10 mm.

Patients who undergo single level endoscopic decompressive surgery are expected to be up and about once the anaesthesia wears off, and can be expected to be discharged the day after surgery.

Therefore, younger patients can look forward to resuming their active lifestyle earlier, while elderly patients burdened with multiple chronic diseases and reduced tolerance for extensive surgical procedures will have reduced trauma to the surrounding muscles.

In contrast, traditional open spine surgery requires a larger incision, which leads to relatively more tissue damage and post-operation pain.

This leads to longer hospital stays, slower recovery, longer rehabilitation, and increases the chance of blood loss and infections.

However, despite the advantages offered by endoscopic spine surgery, it is not the ultimate solution for addressing all types of spinal conditions.

Due to the complexity of the spinal pathology, open spine surgery is still an important and necessary technique, especially when a patient requires a more extensive surgical approach.

Dr Ng Bing Wui is an orthopaedic surgeon. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.