Several disorders are associated with abnormalities of the spine. Many treatment options have been designed to treat such disorders. Endoscopic spine surgery is the one of the treatment options for these disorders.
Endoscopic surgery is superior to conventional surgery in several aspects. Most of the people prefer this surgery because of its several advantages such as, less pain, reduced recovery time, small incision and better cosmetic outcome as compared to conventional surgery . However, sometimes it is not possible depending upon the nature of the problem. It is also known as micro-invasive surgery or key-hole surgery.
Most of the time, endoscopic surgery is carried out to relieve pressure being exerted on the spinal nerves produced by any abnormality in the spine. The steps of such surgery are similar to those of conventional surgery; however, a very experienced and skilled person is required to perform it. The fact is that actual structures are taken apart with your hands and you are playing with the endoscopic instruments during surgery.
First of all, the patient is investigated and diagnosed for what is the actual problem he/she suffers from. After the diagnosis the patient is prepared for the surgery to be done. During preparation of the patient, the fitness of the patient is assessed. Is he/she is fit for anesthesia or not, as well as for facing the surgery. All basic investigations are run to evaluate the patient.
Systemic evaluation is performed by the anesthetist. In systemic evaluation the main focus is on the respiratory and cardiovascular systems. Vitals, i.e. pulse, blood pressure, temperature and oxygen saturation are checked. When everything regarding the patient and surgery is satisfied then the patient is shifted to the operation theatre.
On the operation table, the patient is reassessed and vitals are checked again and are monitored continuously. If patient is fit for anesthesia, general anesthesia is given. In a supine position, the injection is given by an IV canola and endotracheal tube is inserted and attached with the oxygen cylinder or anesthesia machine and so the patient is anesthetized.
The position of the patient is changed from the supine to the prone so that spine is just in front of the operating surgeon.
Antiseptic measures are performed and a small incision is made at the site of operation. The size of incision is equal to the size of the endoscopic slot. A camera is inserted through the micro incision. Gas is injected to make space for the operation and visualization.
Everything is visualized on the screen. Two or more micro incisions are made to insert the endoscope and other endoscopic instruments. This all is done under vision. Muscles are retracted in spite of cutting them. An approach is made to the site of operation. The handling of the endoscopic surgery is very difficult. Therefore, expert hands are needed to perform this operation.
Up till now, the major problem of the patient is solved! Spinal nerves are separated and compression on the nerves is released. Diathermy is used to separate the nerves and to release the compression and bleeding is secured. When all procedures are performed, endoscopic instruments are removed through the ports. The camera is also ejected.
Gas is expelled through the operation site. After that, micro incisions are stitched by the fine sutures to decrease the scar mark. During all this operation, pulse, blood pressure and oxygen saturation of the patient is checked on regular intervals. If any of the vitals is found to be disturbed during the operation, it is managed accordingly.
When stitching is finalized and antiseptic dressing is done over the wound, the patient is reverted back from the effect of general anesthesia. Endotracheal tube is removed and the patient is on spontaneous breathing. Orientation or conscious level of the patient is checked by giving a painful stimulus.
If the patient is responding well to the painful stimulus, he/she is considered out of the effect of anesthesia. Then, the patient is shifted to the recovery room. This is a description of endoscopy spine surgery.
Endoscopic spine surgery is performed for various problems related to the spine of the patient.
Figure 1: In this picture endoscopic spine surgery is shown. In the red circle, endoscopic instruments are shown inserted in the spine through endoscopic ports to remove herniated disc. Pressure is produced on the spinal nerves due to this herniated disc, leading to the abnormal effects. The herniated disc is also shown in the red circle. Pressure on the spinal nerves is released by surgery (Source: www.neurosurgery.ufl.edu).
Figure 2: In this picture, endoscopic ports used in endoscopic spine surgery are shown. Red circle is made around the multiple ports that are inserted in the body of a patient through the skin to perform endoscopic surgery. Through these ports, access to the spine is made for performing surgery. Many endoscopic instruments are inserted through these ports and surgery is done on the spine according to the needs of operation (Source: www.cxvascular.com).
Figure 3: In this picture, small incision marks are shown which are made on the skin in endoscopic spine surgery. A red circle is made around these small incisions. This is one advantage; that very small scar marks remain on the body. Small incisions heal quickly and patient can go to his routine work as early as possible. The size of these scars is also depicted in this picture (Source: www.ciosortho.com).
Here is a summary of why endoscopic spinal surgery is preferred.
Why Endoscopic spine surgery is performed?
Endoscopic spine surgery is an advanced surgical technique and it has many advantages over the conventional spine surgery. Some of the advantages are given below :
- The pain is of very low degree in this operation.
- The healing and recovery time is decreased as compared to that of conventional operation
- The size of incision is very small. It is just like a slit.
- It is cosmetically well as compared to open surgery in which scar mark is of large sized giving a bad esthetic look.
- Spetzger U, Von Schilling A, Winkler G, Wahrburg J, Konig A. The past, present and future of minimally invasive spine surgery: a review and speculative outlook. Minim Invasive Ther Allied Technol 2013;22(4):227-41.
- Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine 2002;27(4):432-8.