What is Endoscopic Spine Surgery?

Minimally invasive spine surgery (MIS), the standard of care in spine surgery, represents a broad spectrum of techniques, with endoscopic being the least invasive. Endoscopic spine surgery is as effective as the MIS microdiscectomy procedure at relieving painful spine conditions.

However, different from MIS, endoscopic spine surgery significantly reduces trauma to the patient's muscles and soft tissue leading to faster recovery. The endoscopic procedure utilizes a surgical approach that avoids the major stabilizing muscles of the lower back.

Unlike the MIS incision of one inch or more, ESS uses a ¼ inch incision. Smaller surgical incisions and avoiding major back muscles can significantly improve patient outcomes.  

Sometimes called ultra-minimally invasive, the endoscopic technique can be performed faster, allowing the surgeon to better visualize and access the spinal nerves and disc.  Also, ESS requires no general anesthesia, which affords patients less risk and faster discharge from the hospital within 2-3 hours of surgery.

Patients are lightly sedated and positioned comfortably on the operating table. The surgeon then locally numbs the skin surgical site to ensure the patient is comfortable throughout the surgery.

Under X-ray guidance, the physician guides a spinal needle and guidewire to the painful and appropriate spinal disc. A micro-incision of ¼ inch is made. A metal dilator (size of a pencil) and cannula are gently placed over the guidewire down to the spinal disc to establish the surgical portal. The guidewire and dilator are removed. 

Specialized micro-instruments are placed through the endoscope to assist the surgeon in ablating and decompressing the affected spinal nerves' pressure. The surgeon often targets and resects herniated disc and bone spurs that may be impinging the spinal nerves.

Laser spine surgery is a marketing gimmick for many, but at DISC, our surgeons utilize a side-firing laser and radiofrequency energy often during ESS as one of many surgical instruments at their disposal.

After surgery, the spinal nerves are decompressed and free from impingement. A steroid injection is often administered thru the scope at the spinal level to enhance patient comfort and minimize post-operative inflammatory pain. The scope and cannula are removed, and one small stitch is used, applying a small bandage on the skin.  

Patients are moved to recovery and monitored for an hour or two before being released to go home.

The goal of traditional or minimally invasive spine surgery is to improve pain by decompressing or relieving pressure and irritation on the spinal cord and exiting nerve roots. During spine surgery, a surgeon is cautious to preserve spinal anatomy and the functionality of the spinal muscles in the patient's back. 

Sometimes, a surgeon's outcomes do not align with patient expectations. Although the surgery has been successful, patients often experience residual pain or pain from surgical disruption of the spinal anatomy and back muscles.