Endoscopic spinal surgery is a form of minimally invasive spinal surgery that employs state-of-the-art surgical technology and techniques with the goal of minimizing tissue injury, especially to the muscles, while still providing treatment results that are equal to those of conventional operations. The principle of this type of surgery is to perform the operation through a single incision via an endoscope less than 1 centimeter in size. The procedure relies on a system that uses lens optics under fluid, which not only helps to provide a clear view of the area being operated on but also reduces bleeding during surgery. The surgeon uses a high-definition monitor while performing the surgery.
Advantages of endoscopic surgery
- Very small incisions of about 1 centimeter and much less post-operative pain.
- Less injury to tissues and bones and minimal blood loss due to surgery.
- Reduced hospitalization time, generally requiring just 1 night in the hospital after surgery.
- Provides the surgeon with a clear view of the affected area, thereby reducing possible complications from surgery.
- Diminishes surgical site infections.
- Reduced scarring internally, ensuring any future spinal surgeries will be problem-free.
- The procedure takes less time than conventional surgery, especially with an expert surgeon.
- Good surgical outcome equal to that of conventional surgery.
Limitations of endoscopic surgery
- Is dependent on the skill and expertise of the physician.
- Surgery is performed in a limited area; therefore, it is not suitable for patients with multilevel disc disease or those who have spinal joint instability.
Indications for endoscopic surgery
It can be used to treat two main disorders, which are the most common degenerative spine conditions:
- Herniated disc
- Spinal stenosis
In addition, it can also be used to treat facet cysts that cause compression of the spinal nerves. Patients for whom endoscopic surgery is suitable often experience the following symptoms:
- Nerve pain, which is lower back pain that radiates through the hip and leg
- Numbness or weakness in the legs
- Claudication, which is pain in the legs when walking long distances that requires you to stop and rest
- In patients with severe nerve compression, there may be bowel or bladder symptoms as well
There are two main surgical techniques:
- Interlaminar approach This involves making an incision in the patient’s back into the epidural space. It can be used in both discectomy surgery—to remove herniated intervertebral disc material—and decompression surgery—to remove the tissue or bone that is causing pressure and pinching of the spinal nerves.
- Transforaminal approach or extraforaminal approach This involves making an incision on the side of the patient’s body through the transforaminal space. It will often be used in a discectomy.
Possible complications of this type of surgery are the same as from conventional open surgery. Although rare, they include discitis, wound infection, and dural tears. It is also possible that it may be necessary to switch from endoscopic to conventional surgery in some cases. There is an approximately 6% incidence of recurrent disc herniation.
In summary, endoscopic surgery is known to be effective, involves minor incisions and minimal tissue injury and therefore less pain from surgical incisions, and requires shorter hospital stays. It can be used in the surgical treatment of herniated discs, spinal stenosis, and facet cysts, with treatment results that are comparable to those from conventional open surgery.
Compiled by Dr. Pritsanai Pruttikul
Orthopedic and spinal surgery specialist
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