Dr. Kris Radcliff on the development of endoscopic spine surgery in the US

Written by Alan Condon | September 24, 2019 | Print  |

Kris Radcliff, MD, is a fellowship-trained spine surgeon with Philadelphia-based Rothman Institute.

Dr. Radcliff discusses endoscopic spine surgery and his concerns for the anesthesia techniques used in the spine approach.

Question: How do you see endoscopic spine surgery developing in the US? Do you see it eventually taking off like it has overseas?

Dr. Kris Radcliff: I've done training for the big three endoscopic systems, but I have not incorporated endoscopic spine surgery much into my practice. There are some clinical issues and some logistical issues that have limited my adoption of the technique. Clinically, I do not have a good sense of the best pathology to treat with this approach versus a traditional microdiscectomy. The current literature is mostly retrospective case series that are somewhat subject to selection bias. Although the results are favorable, clearly there are some situations where endoscopic discectomy is not the ideal technique. Consequently, there is limited insurance coverage for the new current procedural terminology code for endoscopic spine surgery. Overall, I think that the adoption of endoscopic decompression techniques will be limited in the U.S. until there is a good literature about the best clinical indications and wider insurance coverage, such as far lateral soft disc herniations.   

There is also some emerging, interesting literature on endoscopic assisted lumbar fusion. Some aspects of spine surgery are currently performed without the benefit of direct visualization such as pedicle cannulation and endplate preparation. Some surgeons have been able to utilize endoscopic guidance to facilitate those aspects of surgery. I believe that endoscopic assisted lumbar fusion techniques may be the first exposure of many surgeons to endoscopic spine surgery, as the indications are identical to current spine fusion indications. 

Practically, I have some concerns about the anesthesia techniques. Most spine surgeons do not currently perform surgery on awake patients. Although such a wake up test is the best neuromonitoring, few anesthesiologists or surgeons are currently doing that technique. The companies will have to identify ways to perform endoscopic spine surgery using navigation or robotics in such a way that it is familiar to most practicing spine surgeons. 

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