Endoscopic Spine Surgery
Endoscopic spine surgery (discectomy) is a minimally invasive spine surgery (MIS) with only 1 small
incision of 8–10 mm. via endoscope to treat chronic back pain radiating down the leg and hip, as
well as numbness and weakness in the arms and legs caused by a herniated disc, spinal stenosis, or
degenerative disc. Endoscopic spine surgery has an ultra-small incision, reduces blood loss as well
as trauma to the soft tissue, muscle, and bone injuries, and requires only a one-night hospital stay
while offering effective and visible results in treating chronic back pain significantly.
Why endoscopic spine surgery?
Endoscopic spine surgery is an advanced technique that has evolved from traditional open spine
surgery. Earlier methods required long incisions along the back, removal of muscle tissue (open
laminectomy), significant blood loss, large scars, slow healing, and higher risk of complications
such as infection or soft-tissue damage.
In contrast, endoscopic spine surgery uses a small micro-incision through which a specialized
endoscope equipped with a tiny HD camera and surgical instruments is inserted. This allows the
surgeon to precisely remove herniated discs or structures pressing on nerve roots. The endoscope
provides real-time HD visualization on a monitor, enabling highly accurate and safe surgical
movements. The procedure minimizes blood loss, reduces injury to muscles, soft tissues, and bones,
and leads to faster recovery with fewer complications.
What diseases does endoscopic spine surgery treat?
Endoscopic spine surgery can effectively treat the following conditions:
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Herniated disc is caused by deterioration of the intervertebral disc caused by aging, heavy use,
being overweight, or genetics, causing the intervertebral disc that connects between each
vertebra to slip out of place and press the nerve, resulting in back pain, arm pain, neck pain,
hip pain radiating down one or both legs, and tingling, including pain while bending, lifting,
or standing upright. Chronic herniated discs can cause numbness in the extremities, muscle
weakness, and excretory issues.
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Spinal stenosis is caused by the narrowing of the spinal canal along the length of the spine,
including spinal discs, ligaments, and joints, as a result of excessive use, aging, or
scoliosis. Deterioration of these organs enlarges and presses on the spinal cord and nerves,
causing severe back pain, particularly when standing, walking, or arching back, and may cause
pain, tingling, or muscle weakness in the arms, legs, and feet. Mostly found in individuals aged
50 years and over.
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Degenerative disc disease is characterized by deterioration of the spine or joints caused by
aging, excessive use, heavy lifting, accidents, or genetics, and is most common in people aged
25 and up. Symptoms of degenerative disc disease include severe back pain, back tightness or
stiffness, back pain radiating down the hips and legs, numbness, muscle weakness, or severe back
pain when sitting, standing, or walking for an extended period of time.
Indications for endoscopic spine surgery
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Severe back pain, chronic back pain, or ongoing back pain.
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Back pain, hip pain, and shoulder blade pain radiate to the neck, shoulder, or arm.
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Back pain radiates down the hip and into one or both legs.
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Back tension or stiffness, tilted neck, and difficulty moving.
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Burning pain, itching, and tingling.
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Reduced range of motion, difficulty walking, inability to balance, and feelings of falling.
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Back pain when sitting, standing, or walking for an extended period of time.
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Unable to wiggle toes, ankles, or stretch feet.
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Numbness and muscle weakness in the arms, legs, hands, and feet.
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Bowel control problems, difficulty excreting, or urinating.
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Despite receiving medication or physical therapy, the symptoms do not improve.
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Persistent, severe back pain that interferes with daily activities.
What is the diagnosis before having endoscopic spine surgery?
The orthopedist will make a diagnosis before considering endoscopic spine surgery by taking a
history of your back pain, such as where it hurts, how it hurts, how long it lasts, any numbness or
weakness in the organs, bowel incontinence, weight loss, and/or associated fever, as well as whether
you have ever had cancer, and performing a physical examination, including a radiological
examination and front and back photos, as follows:
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CT scan (computed tomography scan) examines the entire spinal structure including spinal discs,
joints, and muscles attached to the spine. the spine's size, shape, and spinal canal to find
abnormalities of the spine, such as deterioration, herniated disc, herniated nerve, fluid-filled
cyst, including internal injuries such as fractures, broken bones, bone deformities, as well as
infections.
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CT myelogram is a diagnostic radiological examination of the spinal nervous system within the
spinal canal by injecting a contrast dye into the cerebrospinal fluid cavity to check for
pathology inside or outside the spinal canal. If there is a herniated disc slipped out of place,
the filling defect will be clearly seen in the cross-sectional image of the examination results.
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MRI (Magnetic resonance imaging) is a 3D examination of the structure of the spine and spinal
cord in order to obtain accurate and clear examination results including the spinal joints,
subarachnoid nerves, spinal disc, or spinal nerves to find spinal abnormalities, such as a
herniated disc, spinal stenosis, or syringomyelia.
Principles of endoscopic spine surgery
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Decompression: To decompress any organ that presses on the spinal nervous system or spinal cords
as soon as possible, such as a herniated disc.
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Surgical stabilization: To stabilize the entire spinal structure and create strength and
stability, for example, if the lumbar spine is loose or mobile, the orthopedic surgeon will fuse
the spine or joints with spacers and screws, making the spine strong and stable without losing
or moving.
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Deformity correction: To correct a spinal deformity or deformed bone structure, such as the
bending of the neck bones, or treat scoliosis, which causes back pain, body tilts, and loss of
balance.
What is endoscopic spine surgery procedure?
Endoscopic spine surgery follows the international gold standard for surgery, focusing on the
patient's safety while minimizing tissue injury and allowing the patient to return to their normal
life as soon as possible. The orthopedic surgeon performs endoscopic spine surgery with an endoscope
to remove degenerated discs or tissues that press on the nerve, helping relieve back pain while
restoring the balance of the spinal structure and joints to keep them strong, stable, and
well-aligned.
Pre endoscopic spine surgery procedures
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The orthopedist will ask the patient to stop taking certain medications 2 weeks before the
surgery, including antiplatelet drugs, aspirin, ibuprofen, naproxen, Plavix, and all herbal
medicines. Those taking Warfarin are asked to be admitted to the hospital 3–4 days before
surgery, thus the orthopedic surgeon can prescribe another short-acting anticoagulant instead.
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Refrain from smoking before and after surgery since cigarettes can obscure the bone fusion
process, reduce bone density, and increase the risk of respiratory infection after surgery.
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Exercise regularly before surgery to reduce and control body weight and help strengthen muscles.
During endoscopic spine surgery procedures
The orthopedic surgeon will perform endoscopic spine surgery by making an 8–10 mm single keyhole
incision (single portal) and inserting a 7.9-mm endoscope with an HD camera into the portal, either
from the back (intralaminar approach) or side (extraforaminal approach) of the spine, using a fluid
system to facilitate the surgery. The endoscope is connected to a real-time external HD monitor
screen, allowing the surgeon to clearly see the condition inside the patient's spine and safely
remove a herniated disc, tissue, or bone that is pressing on the nerve root successfully. The
surgery takes approximately 1–2 hours.
Post endoscopic spine surgery procedures
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The orthopedist will prescribe strong pain relievers to alleviate the pain. Pain and numbness
usually subside over time.
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Patients can sit, stand, walk, and perform light activities for 1-2 hours after surgery.
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The physical therapist will perform physical therapy to aid in the recovery process and teach
the patient how to move safely.
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The orthopedist will ask the patient to stay in the hospital for 1 night to observe symptoms and
evaluate treatment outcomes. If no abnormalities or complications are found, the patient can
return home.
What is endoscopic spine surgery aftercare?
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Patients are advised to wear braces or back support (L-S support) to limit activity and speed up
tissue healing.
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For 1 week after surgery, refrain from lifting heavy objects, bending over, or twisting the
body.
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The orthopedist will schedule an appointment with the patient to remove the stitches 2 weeks
after surgery.
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The pain will gradually improve within 2 weeks.
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Patients can return to work and resume normal activities in 1-4 weeks.
What is the recovery time for endoscopic spine surgery?
Usually, patients undergoing endoscopic spine surgery will take approximately 2 weeks to recover and
can return to work and exercise as usual, depending on each individual's physical strength.
What is the complication of endoscopic spine surgery?
Possible complications of endoscopic spine surgery include post-operative bleeding, dural sac tears,
and surgical site infection. However, these complications occurred in less than 6% of cases, which
is a very low percentage when compared to the significant improvement in back pain.
What is the success rate of endoscopic spine surgery?
According to the results of a survey of patients who had endoscopic spine surgery two years later,
95% were very satisfied with the treatment results, with back, hip, and leg pain significantly
reduced. Patients can stand and stretch straighter; their legs can step wider; they can get up and
down the car or stairs more easily; and they can participate in more activities.
What is the benefit of endoscopic spine surgery?
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Minimally invasive surgery (MIS): Endoscopic spine surgery uses a small incision technique from
the back or side with only one 8-10 mm incision, resulting in less pain, a shorter recovery
period, and faster recovery.
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Precise: Endoscopic spine surgery uses an endoscope, a tubular device attached to an HD camera
with a lens optic under fluid, allowing the orthopedic surgeon to see the exact position of a
herniated disc or any organ pressing on the nerve, resulting in up to 99% effective and precise
treatment.
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Safe: Endoscopic spine surgery has a very small incision (less than 1 cm). This benefit greatly
reduces complications from surgical sites and herniated disc infections, reduces blood loss, and
minimizes muscle, surrounding tissue, and bone injuries.
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Short recovery time: Patients undergoing endoscopic spine surgery can benefit from a one-night
hospital stay and return home the following day. Patients will continue to recover at home for
1-4 weeks, as opposed to traditional surgery, which leaves a large surgical scar and may require
more than a year to recover.
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Cost effectiveness: Endoscopic spine surgery requires only 1 night of hospitalization for
observation. If there are no complications, patients can return home the next day. This benefit
tremendously reduces the cost of hospitalizations greatly.
