Endoscopic Lumbar Spine Surgery
What is endoscopic spine surgery?
Is this new?
The worldwide first case of endoscopic spine surgery was carried out in 1988, with each decade since then bringing improvements in the technology available to established endoscopic surgeons, improved teaching/training programmes available to consultants who wish to expand their knowledge and skill base, and improved outcomes in many cases available to patients needing to visit spinal surgeons due to symptomatic lumbar disc degeneration.
It is a new procedure to this island, with my own first cases done in 2015 and then a 6 year hiatus until I found a more reliable operating system and a more supportive endoscopic spine company (Joimax). I have already been impressed with the safety of this procedure and with the good outcomes achieved.
What are the advantages of this endoscopic option over “traditional” open surgeries?
- Smaller incision.
- No muscle cutting so much less/zero muscle back pain.
- Faster recovery after surgery.
- Reduced risk of infection.
Everything you need to know
Is this endoscopic surgery experimental?
No. It is now an established spinal-surgery subspecialty internationally with outcomes at least as good as “open” microdiscectomy surgery, but with much less tissue destruction and much less recovery time.
What are the potential benefits?
Quicker post-operative recovery time with the option if no improvement accrues of undergoing “regular” traditional open microdiscectomy surgery following an MRI.
What are the potential drawbacks?
It may not work – but then again that’s the biggest potential drawback of any spinal surgery procedure and that possibility is not unique to endoscopic spine surgery.
What happens if it doesn’t work?
If the postoperative pain improvement isn’t what you, the patient, or I, the surgeon, would have hoped/expected, a “standard” microdiscectomy surgery will be discussed. In short undergoing the endoscopic route will allow you to have the potential benefits of the much less tissue destruction, but with the option of the “standard” microdiscectomy being held in reserve if needs be.
When can I go back to work?
I’d advise 3-4 days of a calm relaxed recovery, before returning to work after that, and potentially returning to sports in a sensible fashion 2 weeks later.
What pain killers will I be given going home?
You’ll be given a prescription before you go home. You should continue to take your current pain relief regime, and if pain free then for a period of a week following surgery begin to slowly but steadily decrease your pain medication use until hopefully you’ve discontinued the use of regular prescription medications after 1 month.
When will I be seen again?
Your GP office or PublicHealth Nurse will remove the single suture at the tiny incision site. You’ll be followed up at approximately 6-8 weeks in the Beacon Hospital or TUH or Naas General Hospital with Mr Murphy.
Will I have stitches?
1 or 2 small stitches at the operative incision site.
Is this guaranteed to work?
No surgical procedure is guaranteed to work, and spinal surgery or even endoscopic spinal surgery is no different. The biggest drawback or disappointment associated with any surgical intervention, no matter how old or new, no matter how big or small, no matter how dangerous or safe, is that an individual patient may continue to report symptoms following the intervention. Endoscopic spinal surgery is another option in the treatment of patients with symptomatic spinal degenerative problems, and I am happy to advise any patient if that option is appropriate in their unique case.
Is it less invasive than other surgeries?
No – the same structures are encountered so the “invasiveness” is the same as open traditional microdiscectomy surgery, but the tissue removed/moved/pushed aside and skin incision and bone removal is far far less – which is why the vast majority of patients experience little more than some discomfort in their side over their iliac crest, and therefore the recovery is so much shorter after the endoscopic surgery option.
What does the surgeon actually do during the surgery?
A small “stab” incision less than 1cm in length is made on the side of your greatest pain, between 8 and 12 centimetres (3 or 4 inches approx.) from the midline of your back. A thin long narrow tube is then placed adjacent to the bone of your spine, and then entry is gained to the spine by passing instruments through this narrow tube. Nerves can be decompressed and pain relieved/eased all through this small thin incision.
Will more spine surgery procedures be converted to endoscopic approaches in the next decade?
Yes. At the moment lumbar discectomy surgery is a viable endoscopic option in my practice. In the near future, lumbar stenosis surgery (to remove ligamentum flavum causing lumbar stenosis) will be offered via endoscopic approach. In time cervical spine surgery and thoracic spine surgery will be converted to endoscopic approaches also – as has happened in many centres in the US, Asia and in continental Europe.
Do I continue to train in endoscopic techniques?
Yes. I visit Germany regularly to observe and work with surgeons who have pioneered this endoscopic lumbar spine surgery approach. They act as sensible arbiters of cases that are reasonably approached by endoscopic means at each step of the surgeon’s “learning curve”. I also regularly attend cadaver labs in Europe to use newly developed endoscopic instruments and endoscopic operative approaches before offering them to patients in Ireland with symptomatic degenerative discs.