A new chapter in spine surgery is unfolding, and Vamsi Kancherla, MD, is one of the surgeons writing its opening lines.
Dr. Kancherla performed the first all-uniportal endoscopic lumbar fusion in Georgia at Lawrenceville-based Northside Hospital Gwinnett. He said he began learning endoscopic techniques in 2024 after seeing spine surgery’s eventual progressions.
“When I trained it was really focused on open spine surgery, and then the chapter of minimally invasive spine surgery came along, and that is somewhat of a nebulous work for the general public,” Dr. Kancherla told Becker’s. “But we can look at that as smaller surgery, but achieving the same goals through smaller working portals. This is the next iteration of minimally invasive spine surgery, endoscopic spine surgery.”
Dr. Kancherla likened the shift toward minimally invasive spine and endoscopic spine surgery to the trend to scoping in joint surgery.
“We’ve seen this evolution occur in other parts of the musculoskeletal system,” he said. “We’ve seen it in the shoulder, the knees, the hips and even the ankle,” he said. “Prior to the era of arthroscopy, it was mini-open or wide-open, and those sub specialties evolved. It was a matter of time before spine evolved into that same chapter.”
Dr. Kancherla said the choice to learn endoscopic spine surgery was “a matter of time.” Either wait to see if the technology pans out or if he should jump on the bandwagon early. He decided to jump.
In the digital age, he said he felt it was important to keep up with the technology and that patients come to physicians with more understanding about spine surgery and what they want in their care.
“I jumped into [endoscopic spine] because it was a necessary must in spine surgery and for our community,” Dr. Kancherla said.
Since beginning endoscopic training, Dr. Kancherla has operated on more than 100 levels using the scope, he said.
“This was the first case where I did endoscopic fusion through a uniportal approach. My physician partner, Ben Burch, MD, did the first dualportal approach in Georgia. I’ve evolved from doing medial branch transections or rhizotomy, which is a much simpler solution for back pain, but it’s more of a training ground for endoscopic spine surgery. Then I evolved to doing more discectomy decompression, which is the next level of challenging arthroscopic techniques. Now we’re at the toughest aspect of spine surgery, which is doing endoscopic fusion through, which I think is going to be challenging, but that is the fun of doing them.”
Advancements in neuromonitoring and navigation will help push endoscopic spine through these challenges, Dr. Kancherla said.
And on the reimbursement side of these surgeries, Dr. Kancherla emphasized the importance of value through long-term savings and patient outcomes.
“At this moment in time you have tools such as the scope and a lot of the towers that are used already in the hospital setting,” Dr. Kancherla said. “I do think compared to traditional, say, decompression there is a slight increase in cost due to the equipment needed. From a procedural standpoint, they go as fast or faster than the traditional discectomy or microdiscectomy or decompression pace. The recovery process is also quite robust, and there’s a lower infection profile compared to a traditional or a tubular minimally invasive approach. The hard asset costs, as far as equipment, might be a little higher up front. But the savings can occur with efficiency on surgical time, lowered 90 day readmissions, infections and things that could increase costs in the long run.”
Endoscopic spine can also be an asset for hospital marketing.
“If they can market something that patients are currently seeking, that brings in more folks who are seeking that service to that institution,” Dr. Kancherla said. “At the end of the day, the cost formula, from a hard asset standpoint, might not work immediately, but in the long run, it should be favorable when compared to a more traditional approach.”
