Spinal Endoscopy

What is Spinal Endoscopy?

Spinal endoscopy is a minimally invasive surgical procedure that utilises an endoscope to visualise the spinal structures. The endoscope is a tube with a light and camera attached, allowing surgeons to diagnose and treat various spinal conditions without needing large incisions or extensive tissue damage.

This procedure often treats herniated discs, spinal stenosis, and spinal infections. Spinal endoscopy can also remove bone spurs or decompress pinched nerves.

Who is Suitable for Spinal Endoscopy?

Spinal endoscopy is typically recommended for patients who have not responded to non-surgical treatment methods, such as physical therapy, medication, or spinal injections. It may also be suitable for patients who are experiencing debilitating pain, muscle weakness, or numbness due to conditions like:

• Herniated discs
• Spinal stenosis
• Bone spurs
• Spinal tumours
• Infections of the spine
• Degenerative disc disease

Benefits of Spinal Endoscopy

Spinal endoscopy offers several benefits over traditional open spine surgery:

• Minimally invasive: Spinal endoscopy requires smaller incisions, which leads to less tissue damage and blood loss.
• Shorter recovery time: Because of the procedure's minimally invasive nature, patients often recover quicker and return to normal activities more rapidly than traditional surgery.
• Less pain: The procedure often results in less post-operative pain and discomfort due to minimal tissue disruption.
• Lower risk of complications: There's a reduced risk of infection and other complications compared to traditional open surgery.
• Outpatient procedure: Many spinal endoscopic procedures can be performed as outpatient procedures, meaning the patient can go home the same day.

Types of Spinal Endoscopy

• Lumbar Endoscopic Discectomy: This procedure treats herniated discs in the lower spine.
• Endoscopic Foraminotomy: This procedure is performed to expand the space where nerve roots exit the spinal canal, which can alleviate symptoms of nerve impingement.
• Endoscopic Laminectomy involves removing part of the vertebral bone, called the lamina, to relieve pressure on the spinal cord or nerves.

Alternative Options to Spinal Endoscopy

If spinal endoscopy is not suitable or if a patient prefers to explore non-surgical treatment options first, these might include:

• Lifestyle changes: Weight loss, quitting smoking, and regular exercise can all contribute to spinal health and relieve symptoms.
• Activity Modification:  Avoiding aggravating activities can be required to live with spinal pain.
• Physiotherapy often involves exercises and stretches to increase flexibility, build strength, and improve posture.
• Medication: Pain relievers, muscle relaxants, and anti-inflammatory medications can help manage symptoms.
• Epidural Steroid Injections: These can reduce inflammation around the nerve roots, relieving pain and giving the body a chance to heal.
• Chiropractic Care: Spinal manipulations can sometimes help alleviate pain and improve function.
• Acupuncture: This can sometimes be used to relieve pain, though the efficacy can vary greatly from person to person.

Preparation for Spinal Endoscopy

Before a spinal endoscopy, your surgeon will give you specific instructions, which typically include:

• Medical history and physical examination: You'll be evaluated to confirm you're in good health for the procedure. This often includes blood tests and other diagnostic tests.
• Medications: You may need to stop taking certain medications that can increase the risk of bleeding.
• Fasting: You'll likely need to fast (not eat or drink anything) for several hours before the procedure.
• Transportation: Arrange for someone to drive you home after the procedure, as you'll likely be sedated.

Spinal Endoscopy Procedure

• You'll be given anaesthesia. Depending on the specifics of the procedure, this may be local (you are awake, but the area is numbed), regional (you are awake, but the lower half of your body is numbed), or general (you are completely asleep).
• The surgeon will make a small incision in your back and insert the endoscope.
• Using the camera and light on the endoscope, the surgeon will guide the instrument to the affected area of your spine.
• Once the problematic area is located, the surgeon will perform the necessary procedure, such as removing part of a herniated disc or bone spur or delivering medication to the area.
• After the procedure, the endoscope will be removed, and the incision will be closed.

After a Spinal Endoscopy

You'll be taken to a recovery room and monitored as the anaesthesia wears off. Depending on the specifics of the procedure, you may be able to go home the same day, or you might need to stay in the hospital overnight.

You may experience some pain or discomfort in the area where the procedure was performed. Your surgeon will provide specific instructions on wound care, activity level, and when you can return to work or normal activities.

Spinal Endoscopy Recovery Plan

• Rest and gradual activity: After the procedure, taking it easy and gradually increasing your activity level is important.
• Pain management: Your surgeon will likely prescribe medication for post-operative pain. It's important to take this as directed.
• Follow-up visits: You'll likely need to return to the surgeon for a follow-up visit to monitor your progress and ensure the incision is healing properly.
• Physiotherapy: You may be referred to physical therapy as part of your recovery. This can help strengthen your back and improve mobility.
• Healthy lifestyle: Eating a balanced diet and maintaining a healthy weight can aid your recovery and overall spinal health.

Spinal Endoscopy Prognosis

Many patients experience significant pain relief and improved mobility after spinal endoscopy.

For instance, patients who undergo spinal endoscopy for herniated discs often report immediate relief from symptoms, with most achieving good to excellent results. Similar outcomes have been reported for other conditions, like spinal stenosis.

Long-term success, however, often depends on adhering to a comprehensive rehabilitation program that includes physical therapy, lifestyle modifications, and proper pain management.

Spinal Endoscopy Risks

Like any surgical procedure, spinal endoscopy carries some risks. These include:

• Complications related to anaesthesia: General anaesthesia carries risks, including allergic reactions, respiratory issues, or adverse medication reactions.
• Bleeding: There is a risk of bleeding during and after the procedure, though this is typically minimal with endoscopic techniques.
• Nerve damage: There is a chance of nerve damage during the procedure, which could lead to weakness, numbness, or paralysis, although this risk is generally low.
• Dural tear or Cerebrospinal fluid leak: This can happen if the thin covering of the spinal cord is inadvertently punctured, though it is a rare occurrence.
• Need to open/extend procedure: This can be required if complications occur of the pathology cannot be treated through endoscopic techniques alone. 
• Incomplete relief from symptoms: In some cases, the procedure may not provide complete relief, or symptoms may return over time.
• Infection: Although the risk is low due to the minimally invasive nature of the procedure, any surgical intervention carries a risk of infection.

What if Spinal Endoscopy is Delayed?

The implications of delaying a spinal endoscopy largely depend on the condition being treated. If you have a condition like a herniated disc, delaying treatment could lead to worsening symptoms and a more complicated surgical procedure.

For other conditions, such as degenerative disc disease, delaying surgery may not have significant implications, and non-surgical treatments can often be used to manage symptoms.

In any case, any decisions about treatment timing should be made in consultation with your qualified spinal surgeon, who can best assess your specific situation and needs.