Early, staged endoscopic management of spinal diseases could change the way we look at spine

Written by Alan Condon | January 31, 2020 | Print  |

Endoscopic spine surgery has the potential to become the leading minimally invasive surgical technique for the treatment of degenerative spine conditions, according to an article published in the Journal of Spine Surgery.

Anthony Yeung, MD, of the Desert Institute of Spine Care in Phoenix, and Kai-Uwe Lewandrowski, MD, of the Center for Advanced Spine Care of Southern Arizona in Tucson, examined the early management of spinal diseases and whether early intervention can reduce long-term disability associated with them.  

Dr. Lewandrowski's practice is an outpatient spine surgery center, focusing on early stage intervention, which he believes will be a future subspecialty of spine surgery — interventional pain surgery.

Current advances for the treatment of musculoskeletal conditions, when compared with endoscopic surgeries, have added to costs and contributed to an affordability crisis, according to the paper.

Could endoscopy eliminate cost prohibitive spine procedures?

The authors argue that spinal endoscopy could help eradicate the repetition of less cost-effective procedures currently available in spine and that the staged management approach ultimately reduces disability, utilization and cost.

"We're doing procedures earlier in the disease process to intervene early and give the body the ability to naturally heal an underlying problem before it degenerates to the end-stage of the disease," Dr. Lewandrowski told Becker's Spine Review. 

"If it [reaches the end-stage], it then requires a large, expensive and burdensome reconstruction, which in itself generates the need for complex postoperative care, including more surgeries, admissions and complications, etc."

The authors suggest spinal endoscopy will lead to more targeted treatments based on direct visualization of pain generators, which may open the door for more simplified surgical pain management procedures over aggressive surgical treatments of end-stage spinal disease.

A growing number of surgeons are recognizing spinal endoscopy's ability to alleviate pain, according to the paper, not just by decreasing the size of the incision to reduce morbidity, but also to decrease the parameters of reduced blood loss, peri- and postoperative pain and complications.

Are advantages of endoscopy overlooked?

Drs. Yeung and Lewandrowski laid out two advantages of spinal endoscopy that they believe go unnoticed by most spine surgeons.

First, they highlight the ability to reduce the surgical plan of care to stage the endoscopic treatment plan by focusing on major pain generators. 

Secondly, they point to its visualization ability that enables surgeons to view areas in the intervertebral disc as well in the epidural and foraminal space, which facilitates the analysis of pain generators within a spinal motion segment that traditional spinal imaging may not be able to see.

Drs. Lewandrowski and Yeung's staged management approach implements personalized, preoperative protocols to help understand what pain generator is driving the patient's disability.

These protocols enable them to substantially reduce the patient's pain "without having to address the spinal pathology, which in most elderly patients is multilevel," according to Dr. Lewandrowski.

"We're trying to figure out what's the leading pain generator, treat that and try to get the patient back in the game with less disability," he added. "When you do that in a staged manner, you can manage patients for five to 10 or 20 years with the majority of patients never getting a spinal fusion because the disease doesn't run its full course. Our five-year fusion rate with these protocols is less than 9 percent."

More articles on spine:
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3 hand, spine surgeons from Colorado group offer wide-awake approach — 5 things to know

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