Endoscopic Spine Surgery

What is Endoscopic Spine Surgery?

Endoscopic spine surgery (ESS) is an ultra minimally invasive surgical procedure that effectively relieves chronic low back and leg pain.

This state-of-the-art spine surgery utilizes an HD camera attached to an endoscope inserted through a ¼ inch skin incision to the target pain generator in your spine.

The endoscopic orthopedic procedure allows spine surgeons to operate safely, with greater accuracy, and offer patients better outcomes.

The surgeon can observe the spine on an HD monitor and operate through the endoscope using highly specialized micro-instruments like a laser, radiofrequency probe, or graspers.

Endoscopic Spine Surgery Explained By Dr. Salari

An HD endoscope with an attached HD camera is inserted into the cannula or often called a tubular retractor. The surgeon can now visualize on an HD monitor the spinal canal, vertebral disc and exiting nerves. Endoscopic spine surgery can treat effectively herniated disc, bulging disc and foraminal stenosis.

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What is Endoscopic Spine Surgery
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What are the Patient Benefits of Endoscopic Spine Surgery?

This ultra minimally invasive spine surgery is the most effective surgical technique that relieves a herniated disc, low back pain, and sciatica. Because it utilizes a 1/4 inch incision, patients recover faster than minimally invasive spine surgery.

  • Shorter recovery time and return to work
  • Smaller incision-less post-operative pain
  • Conscious IV sedation and local anesthetic – less risk, avoiding general anesthesia
  • Reduced post-operative infection risk
  • Spine fusion alternative – in individual select patients

This endoscopic spine surgery effectively treats painful conditions caused by a herniated disc, spinal stenosis, sciatica, and facet joint syndrome. This procedure is an excellent solution for patients suffering from pain seeking a faster return to an active lifestyle.

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How is Endoscopic Spine Surgery Different than Minimally Invasive 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, unlike 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 better access to the spinal nerves and disc, and superior visualization. Also, ESS requires no general anesthesia, which affords patients less risk and faster discharge from the hospital within 2-3 hours of surgery.

Image for illustrative purposes only. Your physician will determine the actual incision placement.

An MIS incision versus an ESS incision
Doctors performing surgery in the OR

During and After Surgery

Patients are lightly sedated with IV medication 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 fluoroscopic X-ray guidance, the physician guides a spinal needle and guidewire to the painful spinal disc. A micro-incision of ¼ inch is made. A metal dilator (the 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. 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. Still, 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.

Types of Endoscopic Spine Surgery in Phoenix, AZ

This is the most common least invasive procedure used to relieve the pressure of a herniated disc on a spinal nerve causing pain. It is also called Selective Endoscopic Discectomy, utilizing the world’s first working channel endoscope to perform direct visualized endoscopic spine surgery.

Endoscopic Facet Rhizotomy is an ultra minimally invasive endoscopic procedure treating chronic low back pain caused by facet joints in your back. This procedure has been shown to provide up to five years of long-term relief. If you had short-term relief from a pain management radiofrequency ablation procedure, you might be a candidate.

This is an ultra minimally invasive endoscopic laser spine surgery that targets foraminal stenosis, also called lateral recess stenosis. Lateral recess stenosis can be the cause of failed back surgery in up to thirty percent of patients. The endoscopic technique utilizes motorized burrs and a side-firing laser to enlarge the narrow boney foramen, thus relieving the exiting spinal nerve’s pressure. Endoscopic Foraminoplasty may help select patients avoid a minimally invasive spinal fusion.

Dr. Abrams performing surgery

Endoscopic Spine Surgery

Exceeding Patient-Surgeon Expectations

Traditional or minimally invasive spine surgery aims 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.

  • Endoscopic spine surgery aligns with a surgeon’s expected surgical outcomes and more closely with the patient’s desired expectations.
  • The patient’s desired results are to achieve relief from painful symptoms, restore physical function and resume their quality of life as soon as possible.
  • Endoscopic spine surgery utilizes the least invasive surgical approach that accomplishes a surgeon’s surgical outcome and patient expectations.
  • The surgeon has enhanced visualization and targeting of the spinal canal with less trauma than traditional spine surgery and an MIS microdiscectomy.
  • The result is an outcome that exceeds the surgeon and the patient’s expectations.
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Benefits of Endoscopic Spine Surgery:

  • Shorter recovery time and faster return to daily physical activities, including work
  • Muscle and spine preservation
  • Reduced scarring internally and on the skin
  • Less post-operative pain and less narcotic medication needed
  • The smallest incision in spine surgery – ¼ inch
  • Local anesthesia with mild IV sedation instead of general anesthesia
  • Minimal blood loss
  • Reduced risk of infection
  • Spine fusion alternative – for select patients
  • Outpatient procedure – patients typically leave 2 hours after surgery
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What Conditions Does Endoscopic Spine Surgery Treat?

Endoscopic spine surgery is the least invasive surgical option for patients suffering from back and leg pain. Endoscopic spine surgery treats multiple painful spinal conditions such as:

Are You a Candidate for Endoscopic Spine Surgery?

The ideal candidate for endoscopic spine surgery can vary depending on the specific condition being treated and the surgeon’s assessment. However, in general, the following characteristics may make a patient a good candidate for endoscopic spine surgery:

  • Specific Spinal Conditions: Endoscopic spine surgery is commonly used to treat certain conditions such as herniated discs, spinal stenosis, foraminal stenosis, disc degeneration, and some types of spinal deformities.
  • Failed Conservative Treatments: Before considering surgery, patients typically undergo a period of conservative treatments, such as physical therapy, medication, injections, or other non-surgical interventions. If these treatments have failed to provide adequate relief, endoscopic spine surgery may be considered as an option.
  • Focalized Spinal Issues: Endoscopic spine surgery is particularly suitable for addressing focalized spinal problems. It is most effective when the issue is localized, and the surgeon can directly access the affected area with the endoscope. For broader spinal conditions or extensive spinal deformities, open surgery may be more appropriate.

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Personalized Pain Mapping – Identify the Pain Generator

Our candidate selection process begins with our proprietary Personalized Pain Mapping.  Personalized pain mapping of the spine, also known as diagnostic spinal mapping, is a procedure performed to identify and locate the source of a patient’s chronic or persistent spinal pain. It is a diagnostic tool used by spine specialists to gain a better understanding of the specific areas causing pain in an individual patient.

We listen carefully to your pain journey and your desired outcomes. Then we use diagnostic and therapeutic injections to pinpoint the pain generator. We personalize a treatment plan that will effectively address your pain and desired outcomes. Many of our patients get better without any surgical intervention. However, those patients we select for endoscopic spine surgery have great results and a high level of satisfaction.

Personalize pain mapping of the spine allows for a more accurate diagnosis and helps our expert spine specialist tailor the least invasive and most effective treatment options for patients. 

Detailed drawings of the spine and other bone areas of the human body.

Am I a Candidate?

You may be a candidate for endoscopic spine surgery if you:

  • Have leg pain, numbness, tingling made worse by sitting or bending or arching your back
  • Are not any better after 4 – 6 weeks of conservative treatment, including rest and physical therapy
  • Are not better after epidural blocks
  • Have an MRI, CT scan, CT myelogram, or discogram showing a disc herniation

Due to evolving physicians’ treatment methodology, certain degenerative conditions, if not too severe, can be helped, but only after individual evaluation of each patient and their response to evocative discography and other diagnostic injections can our surgeons tell if the endoscopic procedure is recommended for you.

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Dr Abrams explaining spine x-ray Dr. Abrams laughing

Schedule an Appointment with DISC and Get Back to Living

If you are seeking a second opinion or looking to travel for a less invasive surgery, our orthopedic spine specialists in Phoenix are available to help you get an accurate spine diagnosis and customize an innovative treatment plan to get back to enjoying life. Schedule an appointment with one of our compassionate expert spine surgeons today.


Our spine health blog features up-to-date spine education and expert spine tips from our spine specialists here at DISC.

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