5 things to know about endoscopic spine surgery in 2024


Endoscopic spine surgery has gained interest from physicians as a minimally invasive technique, and it is likely to grow.

Five things to know: 

1. Endoscopic spine cases are more expensive for hospitals than open surgical procedures but are associated with fewer complications for patients, according to a study published in the January edition of the Journal of Neurosurgery: Spine. Researchers looked at data from 633 open and 195 endoscopic decompression lumbar surgical procedures that were performed from 2016 to 2022. They found endoscopic procedures were more costly for hospitals, with disposable supplies accounting for 31.7% of the total cost of cases, compared to 10.1% of the cost for open procedures.

2. Some spine surgeons foresee payer obstacles with endoscopic spine surgery because of the way the procedure is coded. 

"The coding of spinal endoscopy is premature and inconsistent," Saqib Hasan, MD, said. "The early use of endoscopic procedure codes were conflated with percutaneous procedures performed by non-spine surgeons. The lumping of apples and oranges resulted in an inaccurate reflection of the true value of the work inherent to full-endoscopic spine surgery. The key distinction between percutaneous spine procedures is that endoscopy utilizes direct-light based visualization of anatomy, akin to using a microscope and a tube — just on a miniature scale. Hence, coding should reflect that. Payers still sometimes deny these procedures as 'experimental,' despite some of the best randomized controlled studies in spine surgery affirming their benefits and at minimum, equivalence in outcomes."

3. Amplify Surgical saw positive results in a clinical study for its DualPortal endoscopic technique. It is a two-portal technique that helps surgeons perform a variety of lumbar spine procedures. Researchers analyzed 3,673 cases that used the technique for decompressions, discectomies and transforaminal lumbar interbody fusions. The study concluded DualPortal was safe and had favorable outcomes and a low complication profile.

4. Spine devicemakers are paying attention to endoscopic spine surgery. In October, Arthrex launched its portfolio for endoscopic spine.

5. Spine surgeons are expecting endoscopy to grow in the near future.

"The fastest adoption I see coming in the next couple of years will be spinal endoscopy," Brian Gantwerker, MD, said. "We are seeing a rapid uptick in the adaptation of the techniques. I myself have done a handful, and I think for decompression surgery it is extremely impactful. Fusion outcomes being done via this technique I think remains to be really studied in detail. I am a bit leery of it as the basic tenets of fusion require good bone preparation, a large surface area and solid fixation. That being said, if it is found to be not inferior to the standards of lateral, anterior and transforaminal fusions, I see no reason for it to be more popular."

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