The Evolution of Spine Surgery to Endoscopic Surgery

Back Pain

The Evolution of Spine Surgery to Endoscopic Surgery

Spine Surgery has developed into two major categories, Fusion Surgery and Decompression Surgery. For this discussion we will be focusing on Decompression Surgery. This is quite simply freeing up nerve tissue so that is compressed (or pinched).

Spinal nerves and bones are a system of dynamically moving structures. The bones create support and protect the nerves. The nerves control the functions of your muscles, sensation of skin, pain, and many other vital functions. Another important thing to realize is that the never move when you move. For example, and nerve coming out of the hole in the lumbar spine move in and out approximately 4 inches at a time, back an forth, which is a dynamic system. Unfortunately, when problems happen to your spine the nerves can get compressed and this causes friction on the nerve. The reaction of the nerve is to swell with inflammation. This makes the problem even worse since the nerve is now larger, and can not fit in the same compressed location and continue to move, so it gets stuck. This can cause pain, numbness and even weakness wherever this nerve goes.

For example, a lumbar nerve compressed and swollen can cause sciatica (pain down the leg).
In decompressive spine surgery, the surgeon surgically removes the problem, and therefore removes the compression of the nerve which frees the nerve (decompresses the nerve). In the case if a disc herniation compressing a nerve(pinching), the surgeon removes the disc herniations and the nerve is now free to move again. There is many more examples of ligaments, bone, and other tissues compressing nerves, and decompressive spine surgery removes them and allows the nerve to remove the problem tissue and allows the nerve to gain be free.

Many years ago, spinal decompressive surgery was done through large incisions (i.e. open), big enough so that the surgeon could see the tissues with the naked eye. Technology advanced and there was a growing need to make smaller incisions to be able to minimize the trauma and therefore make recovery less painful and shorter in duration. Another reason was that the healing of human tissue creates scar, and scarring around nerves can trap the nerves, compress the nerves and create the same problems as herniated disc on the nerves. This scarring after spinal surgery can develop over approximately 2 years.

Surgeons noticed that approximately 2 years after an open spine surgery that some patients would return with similar symptoms and scar trapping nerves was frequently the problem, leading to the creation of the diagnosis Failed Surgery Syndrome. In 1967, lumbar microscopic disc surgery was created, which was a surgery that was done through a tube. The incision as about one inch long and the tube went through the muscles and tissues to allow the surgeon to have a focal view of the spinal nerve and disc. This is done with a large microscope that creates light and vision down the tube with instruments to decompress nerves. This procedure is still very common today. Many times you will hear this called Minimally Invasive spine surgery. It is a great advance over open surgery due to faster and less painful recovery, but unfortunately this surgery does create scar, and can still lead to Failed Surgery Syndrome.

Endoscopic Spine Surgery is the current State-of-the-art and is starting to evolve in the USA. The endoscope used can range from 7-10mm in width, which is much smaller than microscopic surgery. The endoscope has built in it a video camera, instrument channel, light source, and fluid irrigation channel. The image of the surgery is on a large TV monitor in the operating room. The instrument channel allows for a variety of surgical instruments it be used such as graspers, drills, and scissors, just to name a few. The surgery is done within a fluid bath with water continually. The video monitor view creates much more magnification and much more fine surgical accuracy. Endoscopic Spine surgery does not create scar, or creates very little, which is a major improvement of endoscopic surgery for patient long term outcomes. The mechanism of why scar is so minimal is not understood yet.

Michigan Pain Specialists is a leader in Endoscopic Spine surgery. Make an appointment with our doctors to learn more about this exciting new technology. Also please look at 

Endoscopic Discectomy
Endoscopic Decompression

Louis D. Bojrab, MD, FIPP Interventional Pain Specialist at Michigan Pain Specialists, PLLC

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