Endoscopic Spine Surgery

What is endoscopic spine surgery (ESS)?

Endoscopic spine surgery (ESS) is a state-of-the-art surgery performed by very few spine surgeons who have been specially trained. ESS uses a small tubular system with a pen-tip sized incision assisted with an endoscope for visualization. This surgery provides patients with an even quicker recovery and less pain compared to traditional spine surgery as well as minimally invasive tubular spine surgery (MIS).

Advantages of Endoscopic spine surgery include the following:

• Microscopic incision the size of a pen tip (a single bandage)
• No blood loss
• Immediate recovery
• Almost no pain meds
• Preservation of spinal mobility (meaning NO fusion)
• Mostly local anesthesia
• Same day outpatient surgery
• High success rates
• Improved quality of life
• No removal of muscle or bone
• No scar tissue

Endoscopic spine surgery should not be confused with traditional procedures—such as minimally invasive, micro invasive and/or laser spine surgeries. In the experienced hands of a spine surgeon who regularly performs endoscopic spine surgery using tubular retractors and the endoscope. Think of endoscopic spine surgery as arthroscopy of the spine.

How is endoscopic spine surgery performed?

A 10 millimeter or smaller skin incision (pen tip sized incision) is made and a tubular trocar (about the width of a pencil) is inserted. Depending on the patient’s condition, the endoscopic technique may access the spine using one of two approaches: either an intralaminar (from the back of the spine between two laminae) or transforaminal (from the back/side of the spine into the neuroforamen; a nerve passageway) approach.

Next, a tiny camera is inserted into the targeted area of the spine. Throughout ESS, the camera captures and projects real-time images of the operative site onto a monitor in the surgeon’s direct view. The endoscopic camera assists and guides the surgeon during the surgical procedure. The images and videos of the disc bulge and nerve root are provided to the patient following surgery.

Are you a candidate for endoscopic spine surgery?

Many patients who are candidates for endoscopic spine surgery have been diagnosed with common types of spinal disorders. Some of these diagnoses include moderate to severe disc herniation, disc bulges, facet arthropathy, sciatica, and spinal stenosis.

How long does it take to recover from endoscopic spine surgery?

All patients are able to leave the same day and are walking immediately after discharge from the surgery center. Normal activity can be resumed in as little as one week.

How soon can I leave the hospital after surgery?

With endoscopic spine surgery there is no need to have your surgery done in the hospital! This means you go home the same day after surgery. Typically, patients leave the surgery center 1-2 hours after the surgery is completed.

How long will it take before I can get back to work and exercise?

While the specific length of your recovery will depend on your surgery, most patients are able to return to their light-duty jobs within 24-48 hours after surgery. The time frame to return to work and exercise depends on many factors other than the endoscopic surgery including your physical health (diabetes, heart disease), your job (light demand versus heavy) and the type of surgery you undergo (minimally invasive endoscopic laminectomy/discectomy versus fusion).

Will there be a scar from my surgery?

Endoscopic spine surgery results in very minimal if any scarring. The incision made is smaller than the size of your pinky fingernail.

Is endoscopic spine surgery painful?

Patients undergoing endoscopic spine surgery will be put under general or even local anesthesia, meaning that you will not be able to feel pain throughout the course of your surgery. Most patients are awake while the procedure is being performed!

Will endoscopic spine surgery permanently fix my spine issues?

Depending on your specific spinal condition, endoscopic spine surgery can permanently treat conditions in the spine. Most spine pain is caused by disc herniation or degeneration that is putting pressure on the sensitive nerves that travel through the spinal column. Endoscopic spine surgery can clean up the area around those nerves and relieve the pressure. However, for more serious, degenerative spinal conditions, further surgery may be required.

How many minimally invasive surgeries has Dr. Kern Singh performed?

Dr. Kern Singh has performed over 5,000 minimally invasive surgeries and has published over 500+ papers and book chapters on the topic. Additionally, he has been invited to give lectures all over the United States and the world (Columbia, Harvard, Cedars-Sinai, Saudi Arabia, Japan and India to name a few).

How is endoscopic spine surgery different from open spine surgery?

Unlike open spine surgery, which requires surgeons to cut through muscles and soft tissue when accessing the spine, in endoscopic spine surgery, the tissue is gently pushed to the side. Imagine a knee arthroscopy for an ACL tear versus opening up the whole knee for a knee replacement.

In terms of visualization, the endoscope is second to none. With the high definition camera and a powerful light source, physicians are able to see exactly where they are working and what is occurring in the back at all times.

How does endoscopic spine surgery work?

In endoscopic spine surgery, a surgeon will make a small keyhole incision in the back, often about 7mm (smaller than a dime), and place a specialized camera down to the affected area of the spine. This endoscope is an instrument specially created for spine surgery, giving enough room for a high definition camera and light source as well as a working channel for the surgeon’s instruments.

Who will need endoscopic spine surgery?

Patients with neck pain, limb pain and back pain are indicated for surgery if they are not better after six weeks of conservative treatment. Patients with lumbar spinal disc herniations, regardless of their sizes and locations, can be effectively treated with endoscopic spine surgery. Spinal stenosis, bone spurs, slipped vertebra, and spinal joint arthritis can be effectively treated as well. Endoscopic spine surgery is also applicable to patients whose traditional spinal surgeries have failed.

What are the risks involved with this type of surgery and how common are they?

Fortunately, with endoscopic spine surgery, the risks are very small. Theoretically, infection can happen but it is extremely rare (1 in 1000) as there is almost no incision. Most of the endoscopic surgeries are performed under local anesthesia so general anesthesia is avoided. The most common risk is that because of the severity of the disk herniation or stenosis the pathology cannot be completely addressed. With that being said, 90% of patients report significant pain relief following endoscopic spine surgery.

How much post-operative pain can I expect and what medication will I be given for pain?

An endoscopic discectomy takes about an hour. You shouldn’t experience a great deal of pain afterward but may feel a little sore. You don’t even have to worry about stitches; your incision will simply be covered with a bandage. It takes about an hour to recover from the procedure in our outpatient surgical facility and then you can go home. After that, you’ll need to see how your body responds to the surgery. Most patients feel better right away and can return to work in a couple days. It’s important to listen to your body and discuss your symptoms with your doctor to ensure you are ready to resume normal activities. Avoid heavy lifting until your doctor gives you the okay, even if you feel fine.

How long will I be out of work and when can I drive?

The time of recovery for the endoscopic discectomy procedure depends on the type of work you do. For people who do office work and other kinds of sedentary jobs, the time of recovery is usually one to two days. For more active people, like athletes and those who move around more often during their regular workday, the time of recovery may be four weeks. Driving is restricted for 2 weeks after surgery, not because of medical or surgical issues, but because of the liability of being in an accident following spine surgery.

Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation?

I am the one who performs the entire procedure. My physician assistant is there to help assist me during surgery. No students or trainees are allowed to perform the surgery.