What is Microendoscopic Spine Surgery?
The vast majority of spinal problems that require surgical intervention involve pressure on the nerves, which results in neck, arm, back, and/or leg pain. Spine surgery for these conditions typically involves making an incision in the neck or back and utilizing various instruments to remove the elements of bone and disc and tissue that are causing pressure and pain. Traditional techniques involve cutting and moving large muscles and ligaments to allow access to the spine. This results in changes that permanently alter and weaken the muscles and ligaments, and may result in the need for future surgery and fusion. Microendoscopic surgery uses small tubes and an endoscopic camera (similar to a knee or shoulder scope) to provide access to the spine for decompression through a small incision, which is placed between muscle fibers, and hence, preserves the muscles and ligaments that support the spine, allowing many patients to avoid fusion surgery.
How is Microendoscopic Surgery different from traditional minimally invasive techniques?
Traditional minimally invasive techniques involve the placement of smaller retractors and direct visualization with a microscope or loupe (eyeglasses) magnification. These traditional techniques provide limited visualization to the neurologic structures resulting more commonly in incomplete decompression of the nerves and persistent symptoms of nerve compression, like arm or leg pain.
Microendoscopy for the spine is similar to arthroscopy for the knee and shoulder and represents the next generation of spine surgery. Microendoscopy techniques utilize a camera placed inside the tubular retractors so that the surgeon can better visualize all the neurologic structures through smaller incisions than those needed for traditional minimally invasive techniques, meaning patients have a better surgical outcome with faster recovery, and avoid permanent damage to the muscles and ligaments that support the spine.
What about “laser” surgery?
“Laser” spine surgery is for the most part a term used for marketing purposes to attract patients. A laser is a tool for cutting, similar to many of the other tools used in spine surgery. Physicians who claim to perform laser surgery do still need to make an incision and use traditional techniques before using the laser for a small portion of the procedure to remove some part of the soft tissues. Many companies or physicians claim that “laser” spine surgery is more efficient or effective than traditional minimally invasive techniques, but there is no real medical evidence for the use of lasers in spine surgery. In fact, the North Amercian Spine Society (NASS), which is one of the largest and most reputable international organizations of spine surgeons, recently reviewed all the evidence on the use of lasers in spine surgery and concluded that there was “no clear evidence for the use of lasers in spine surgery”.
What is the evidence for Microendoscopic spine surgery?
There is a great deal of medical evidence for microendoscopic spine surgery, demonstrating the quality of the outcomes and the improvement in postoperative recovery. Microendoscopic decompression (MED) has been performed for over a decade in various places throughout the world, in particular in Asia and Europe. There are hundreds of journal articles, many published in the most reputable spine journals, demonstrating the proven benefit of endoscopic and microendoscopic techniques. In fact, several of these journal articles were written by the spine surgeons at MSI and their colleagues in Japan, who are among the worlds best microendoscopic spine surgeons.