Ben Burch, MD, has played a key role in growing endoscopic spine adoption in the South starting with Mississippi and more recently in Georgia.
Dr. Burch, who performed Georgia’s first endoscopic spinal fusions with Gainesville-based Specialty Orthopaedics, spoke with Becker’s about his experience and outlook for the technology.
Note: This conversation was edited for clarity and length.
Question: What has been your experience with endoscopic spine? How did you approach the learning curve?
Dr. Ben Burch: I was in private practice in Mississippi previously, and that was when I was straight out a fellowship. I actually never had any sort of formal training in endoscopic spine during my fellowship training or residency because back then it was very rare in the U.S. I was largely self taught. I did a lot of reading, a lot of researching on my own and did several cases, before attending my first lab. I do both uniportal and biportal approaches, and have grown my skill set over the past several years. I’m also a consultant with several companies where I teach endoscopic techniques to other surgeons. It’s been a fun journey, and it’s really transformed my practice, especially over the last three years.
Q: To what extent is this improving your day-to-day work?
BB: What’s interesting about endoscopic spine surgery is that the technology that’s used is very similar in a lot of ways to arthroscopic surgery. My background included training in joint arthroscopy, so I was formally trained on scoping, knees, shoulders and hips. That technology, if you think about the operating room and the setup, is now being applied to the spine. When I’m working with new staff members, especially in an ASC, that’s how I explained it to them. It’s very similar to scoping a joint, but now you’re scoping the spine, so it relies heavily on an understanding of that type of technology, but also understanding the general spine anatomy.
You’re just applying the technology to the anatomy of the spine. Day to day it depends on what we’re tackling, but a lot of my cases are decompressions. But now we have completed the first several endoscopic fusions in Georgia. Depending on the approach, whether uniportal or biportal, lends itself to different applications. There’s various end goals that we can achieve to treat different pathologies based on selecting the appropriate approach.
Q: Can you give a quick breakdown of how you’re deciding who’s best for uniportal versus biportal endoscopic spine surgery?
BB: In my practice, uniportal is very applicable for unilateral pathologies, especially pathologies that are easily reachable with a straight board triangulation or trajectory. Those may include foraminal stenosis where the nerve is exiting the spine whether it’s in the lumbar spine or in the cervical spine. I like to do uniportal approaches for many of those types of pathologies and disc herniations that are very far out to the side.
For biportal, I consider a more of a traditional spine surgery approach. You can do more central work in my opinion, so central decompression and larger working areas. I also use it with fusion work if you’re cleaning out the disc space. It just really depends, and that probably varies from surgeon to surgeon on preferences, but in my hands, that’s a general breakdown.
Q: Adoption has been a bit slower in the US compared to other countries. Do you see Atlanta in the South as a potential hub for endoscopic spine adoption or training, or are things still fragmented?
BB: I’ve done several labs here in the Atlanta area with surgeons from the area who are interested in adopting this technology in their own practices. I think it’s a great way to add something to your practice. But more importantly, it’s good for patients. It’s good to have a minimally invasive approach, where folks are bouncing back quickly and have less pain after surgery and great outcomes. But as you mentioned earlier, there is a learning curve. I think some surgeons are hesitant to dive into that. I understand that, but once you adopt the technology and embrace it, you start to see it blossom. And I experienced that in my own practice as well. It’s just very rewarding.
Q: What’s an improvement in these endoscopic tools that you think would really accelerate adoption in the U.S.? What do you want to see in an endoscopic spine, 2.0?
BB: Any advancement in scope technology is always welcome, but the scopes are already fantastic. I think the biggest step forward is going to be improvements in intraoperative navigation. I use the analogy a lot of building a ship in a bottle. That’s kind of what endoscopic spine surgery is. We’re still doing all of the work deep inside the body. We’re still doing the work at the level of the spine that you would do from a traditional surgery, but we’re doing it through very small openings. It’s like building a ship in a bottle to do that. You need to have a very good understanding of anatomy, and that requires use of things like intraoperative fluoroscopy and X-ray to triangulate and get the right angles and the right trajectories. As interoperative navigation technology advances, especially if you bring it to the ASC setting, a lot of surgeons will feel more comfortable adopting that technology and being able to see instead of just relying on 2D imaging. Navigation technology will help folks adopt this faster or easier in the future.
