'A true paradigm shift': 6 surgeons on endoscopic spine surgery


Endoscopic spine surgery offers many benefits over traditional spinal fusion, including shorter operative times, less bleeding and quicker recovery times.

Awake endoscopic procedures also avoid intubation, protecting staff from exposure to respiratory secretions directly from the lung, which has become a particularly useful tool for surgeons during the COVID-19 pandemic.

Six spine surgeons share their thoughts on endoscopic spine surgery:

Peter Derman, MD. Texas Back Institute (Plano): I am also excited about endoscopic spine surgery, which is becoming an increasingly large part of my practice. It is a true paradigm shift in the field, which allows surgeons to access and address spinal pathology without the morbidity associated with traditional techniques. In many cases, it allows me to perform an ultra-minimally invasive decompression when a fusion might otherwise have been necessary. Patients are comfortably home within hours of surgery and often only take Tylenol for postoperative pain control in the days after the procedure.

Daniel Lieberman, MD, Phoenix Spine & Joint: What patients really are concerned about is their pain. Our surgery centers offer endoscopic dorsal rhizotomy, so ultra-minimally invasive surgeries that eliminate pain are really the next horizon. It's almost like we're going to see spine surgery absorb and move into more of a pain management approach, rather than a structural correction approach. 

Kern Singh, MD. Midwest Orthopaedics at Rush (Chicago): This is truly the next generation of spine surgery. I've been performing minimally invasive spine surgery for 13 years and now with the endoscopic procedure, my patients are out of the surgery center in usually half the time. Being able to provide this procedure to my patients means I can deliver them pain relief in an even safer manner.

Raymond Gardocki, MD. Vanderbilt University Medical Center (Nashville, Tenn.): I expect endoscopic interbody fusion to grow significantly. I also expect that outcomes data will be collected, showing higher fusion rates and less subsidence due to better visualized disc prep and less endplate violation. Look for new instrumentation advancements and technique refinements that make this procedure feasible for more surgeons to perform outpatient and awake one- and two-level lumbar fusions. I think this will lead to more mainstream acceptance and use of endoscopic spine surgery. 

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Current techniques in endoscopy look promising, although I am not totally sold on endoscopic transforaminal lumbar interbody fusions. I think decompressions and discectomies will all be done endoscopically in 10 years.

Issada Thongtrangan, MD. Microspine (Phoenix): Outpatient spine surgery, endoscopic spine surgery and motion preservation are the most exciting trends for me. The advanced technologies of endoscopic spine are evolving to the point that this can be done in an outpatient center. We can incorporate nonfusion and even fusion techniques with the endoscopic technique. In Asia and Europe, there are several studies showing comparable outcomes on endoscopic lumbar fusion utilizing expandable cages and endoscopic tools.

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