Endoscopic Spine Surgery
What Is Endoscopic Spine Surgery?
Endoscopic spine surgery is one of the least invasive versions of minimally invasive spine surgery. Some surgeons term it as the bridge between pain procedure and traditional open spinal surgery.
Read on to find out how endoscopic spine surgery works, its benefits and what conditions it’s suitable for.
How does the endoscope work during spine surgery?
The endoscope used in endoscopic spine surgery is 8-10mm in diameter and serves 4 functions:
1) Irrigation – saline from the inflow port of the endoscope washes out tissue and blood clots that need to be removed.
2) Magnification by lens– the camera on the endoscope helps doctors visualise nervous tissue, improving safety and outcome of surgery.
3) Light source – the endoscope lights up the surgical area for treatment by doctors.
4) Working channel – delicate endoscopic instruments can be passed through a small working channel in the endoscope to treat the target disc, bone or nerve region.
Benefits of endoscopic spine surgery
Endoscopic spine surgery has several benefits over open spine surgery. Here are the main ones:
Reduced trauma – A spinal endoscope can be inserted directly on target bony region, bypassing soft tissue to prevent repetitive trauma to soft tissue.
Minimised collateral damage – An endoscopic spine surgeon can “dock” on the target area to minimise damage to surrounding areas.
Easier access to treatment areas – As the endoscope is small in size, a doctor can fit it into spinal cavities such as the spinal foramen to perform decompression of nerves and remove a herniated disc.
Local anaesthesia – Due to the above mentioned reasons, endoscopic spine surgery can be performed under local anesthesia with moderate sedation.
Illustrations of endoscopic spine surgery
What Are Different Types of Endoscopic Spine Surgery?
Endoscopic spine surgery is divided into uniportal and biportal endoscopic spine surgery. Due to the evolution of endoscopic spine surgical technique, more and more conditions can be treated endoscopically as a day procedure.
At Achieve Spine and Orthopaedic Centre, we can convert up to 80% of our load of traditional open spinal surgery to endoscopic spine surgery. In selected cases, they can be performed as outpatient day surgery centre procedures.
Patients should speak to their spinal surgeon to decide whether he/she is suitable for endoscopic spine surgery in their practice.
What Conditions Can Be Treated with Endoscopic Spine Surgery?
In an experienced spinal endoscopist’s hands, spinal endoscopy is suitable for most spinal areas that are damaged, including the cervical, thoracic and lumbar spine.
Cervical spine
The cervical spine refers to the section of the spine located in the neck, consisting of seven vertebrae that support the skull and facilitate motion in the neck. When this area is damaged, you may suffer from neck and arm pain and other issues. These can be treated through a procedure called posterior endoscopic cervical decompression.
Thoracic spine
The thoracic spine is the middle section of the vertebral column and is made up of twelve vertebrae labeled. It’s situated between the cervical spine (neck) and the lumbar spine (lower back). The thoracic spine extends from the base of the neck to the abdomen and chest area.
Issues with the thoracic spine, such as fractures, degenerative conditions, or herniated discs, can cause pain, stiffness, or even nerve-related symptoms. In solving these problems, endoscopic spine surgery can be a good alternative to traditional open chest/ open back thoracic spinal decompression. (Figure 4 A and B).
With thoracic spinal endoscopy, in selected cases, one can avoid opening the chest and inserting a chest drain. However, both open and endoscopic thoracic spine surgery pose higher risks than a lumbar procedure. One should consult an experienced spinal endoscopist for thoracic spinal options.
Lumbar spine
The lumbar spine refers to the lower part of the vertebral column, consisting of five vertebrae. It’s located beneath the thoracic spine (mid-back) and above the sacrum (a triangular bone at the base of the spine). The lumbar spine supports the weight of the upper body and facilitates various movements, such as bending, twisting, and lifting.
The lumbar spine is the region where spinal endoscopy is applied most of the time for conditions such as sciatica, lumbar radiculopathy, lower back pain, spinal stenosis with neurogenic claudication ( patient presents with leg pain/numbness/weakness after walking a certain distance which improves with sitting down), spondylolisthesis (patient presents with back pain and leg pain when changing position or walking prolonged duration) and prolapsed intervertebral disc( herniated disc). In our experience, close to 90% of degenerative lumbar spinal conditions can be treated with endoscopic spine surgery and majority as ambulatory day surgery.
What Are the Potential Risks and Complications Associated with Endoscopic Spine Surgery?
Recent systematic review and metanalysis of a large pool of data studies show endoscopic spine surgery has a favourable safety profile compared to open surgery. The risk of dura tear, blood clot formation, nerve injuries, and infection is lower on endoscopic spine surgery. In our experience, less than 1% of patients require blood transfusion after an endoscopic spine surgery and are usually discharged within 24 hours.
Who Is a Candidate for Endoscopic Minimally Invasive Spine Surgery?
Anyone with a spine condition could benefit from endoscopic spine surgery because of its short downtime. However, some people with particular conditions may be especially good candidates for the procedure. They include:
- Elderly who are frail, with heart issues, and are unfit for general anesthesia.
- Patients who have eczema, diabetes, and other conditions that may hinder proper wound healing
Can Endoscopic Spine Surgery Be Used for Spinal Stenosis?
Spinal stenosis is a condition characterised by the narrowing of spaces within the spine, which can put pressure on the nerves and the spinal cord itself. Much of our case load consists of treating this condition, from one to multiple-level spinal stenosis.
Studies show that endoscopic spine surgery can potentially preserve the facet joint better with minimal soft tissue injury. This is important in maintaining stability in the spine for patients who have experienced spinal stenosis decompression.
How Long Does an Endoscopic Spine Surgery Typically Last?
Endoscopic spine surgery, in our experience, lasts between 30 to 60 minutes per level.
At Achieve Spine & Orthopaedic Centre, our Director and Consultant Dr. Wu Pang Hung, is an internationally acclaimed spinal surgeon with a comprehensive background in endoscopic spine surgery. Dr. Wu’s dedication to advancing endoscopic spine surgery has earned him recognition from various local and overseas media outlets.
If you or a loved one are considering endoscopic spine surgery in Singapore, consider scheduling a consultation with Dr. Wu to take the first step towards a pain-free life.
What is the Cost of Endoscopic Spine Surgery in Singapore?
The approach and equipment used in each procedure vary. You will need to discuss with your endoscopic spine surgeon to find out what meets your needs and the cost that will be incurred.
Frequently Asked Questions (FAQs)
Not all spinal conditions require surgery. You should talk to your doctor to know if endoscopic spine surgery is the most suitable one for you.
Yes, the endoscope was originally designed and targeted to treat herniated discs. It allows the removal of disc fragments with minimal soft tissue damage. Endoscopic spinal discectomy can be performed as an ambulatory day surgery procedure in one or more levels of the spine.
Patients are encouraged to walk and move their limbs as soon as the anesthesia wears off, typically 4-6 hours after surgery. Once patients ambulate well, he/she can be discharged for light duties and to rest at home. The patient is encouraged to walk around his neighbourhood and at home, and do some prescribed exercises during the first 2 weeks.
Patients are discouraged from carrying heavy items and bending their spines excessively during the first 6 weeks of recovery. After this period, they may gradually increase the weight of the load they carry and progressively do more strenuous exercises, aiming to do normal activities 3 months after surgery.
We have performed many revision surgeries for patients who had previous spinal surgeries. The precision, illumination, magnification, and constant irrigation brought about by spinal endoscopy make it favourable to revise spines that had previous surgery with scarring. Endoscopic spine surgery also decreases the rate of wound infection.