Dr. Tony Mork on endoscopic spine surgery and spine surgeons vs. pain management physicians

Written by Alan Condon | December 05, 2019 | Print  | Email

Tony Mork, MD, is a Newport Beach, Calif.-based endoscopic spine surgeon who is cofounder of Microspine and founder of the Endoscopic Spine Academy.

Dr. Mork purchased his first commercially available endoscope in 2001 and has performed more than 8,000 endoscopic spine surgeries.

Here, Dr. Mork discusses the Endoscopic Spine Academy and the dividing line between spine surgeons and pain management physicians.

Note: Responses are edited for style and clarity.

Q: When did you develop the Endoscopic Spine Academy? How has it progressed over the years?

TM: I've been teaching endoscopic spine courses in the U.S. for six years and there's two types of physicians that are usually interested: pain management physicians and the neuro orthopedic surgeons. They come from different backgrounds. Spine surgeons tend to not worry as much about small things that cause pain, like facet syndrome and the pain management physicians want to enter the surgical arena, but often don't have the surgical training. The dividing line is the spinal canal — spine surgeons feel that this is their territory and they don't think anyone else should be doing it. But when you come to the courses as a pain management physician, there's not really a guided system, so I'm teaching things that perhaps they shouldn't be doing. The medical groups and companies are trying to promote the specialty and sell their instruments, but there isn't really a guided pathway. 

About two years ago I began developing a program, with the first courses for the pain management physicians. It's a guided course starting with easy techniques that you would have a hard time hurting anybody. You begin to develop your skillset and progress through the next courses. The third course is thoracic and then the fourth one is inside the disc. None of them are in the spinal canal. This has been a real philosophical sore spot for everyone who attends these courses. The surgeons don't like the pain management physicians operating in the spinal canal and the pain management physicians are asking why not. It has become a controversial area. To relieve some of the frustration and provide a type of guided pathway, I thought I would make a set of four courses for the pain management physicians and if they progress through them, they may establish good relationships with some of the spine surgeons and there would be little controversy. Next year, I'll be doing courses for spine surgeons.

Q: What has been the prevailing mindset of spine surgeons in the endoscopic courses? Is it one of curiosity? Do they come away planning on incorporating it into their practices?

TM: I think they're mainly curious but there's really all levels of interest. The fellowship trained spine surgeons typically work inside the spinal canal. It really takes some practice to navigate endoscopically inside the spinal canal to know where you are and to do these surgeries adequately and safely. I think it's one of those things that you either commit yourself to this kind of practice or you dabble a little bit and just give it some lip service. 

In spine surgery there's really only three things you can do — fuse, decompress or divide the sensory nerves that go to a particular area. So, you're looking at how you're trying to approach the spine. Do you want to take the motion away because you believe no motion, no pain? Or do you believe that everything should continue to be moving and you're just trying to decompress or give the nerves some breathing room? It's almost a philosophical dividing line.

Q: What is your goal for the future of the Endoscopic Spine Academy?

TM: It's really a two-pronged process. My primary goal is to promote the specialty by giving physicians adequate educational resources that can be accessed anytime, so if they were to take this course there's nothing left out. It covers anesthesia, positioning, how to do the surgery and even how to do the dictation. Initially it's the education of the physician. I had endoscopic spine surgery on my neck and it worked out very well. So, not only am I encouraged by the positive results for my patients, but my own procedure too. Endoscopic spine surgery shortcuts a lot of the problems that you see with many larger surgeries, particularly fusions.

Although my success percentage is very good, I don't resolve everybody's problem. If I do a surgery and it doesn't work out to help a patient, they're essentially left with the same options they had before the endoscopic procedure. However, if you do a fusion and it doesn't work out, not only is the patient still in pain, but it may be worse, and they have limited options. My goal for the pain management physicians is to offer an endoscopic approach to definitively cure a patient's pain rather than managing it, particularly from pain that originates outside of the spinal canal. My next project will be to educate and make people more aware of this technology before they decide to go on to a bigger surgery like a spinal fusion. 

Find out more about endoscopic spine surgery on Dr. Mork's YouTube channel, which surpassed 1 million views last month.

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