What is full-endoscopic spine surgery: discectomy or decompression?

It's a keyhole surgery, on the lower back, through an 8 mm incision in the skin:

Full-endoscopic: A display linked to a high-definition camera shows the video image of the endoscope located in the surgical area.

Discectomy: Removal of the bulge on the back shock absorber ('discus') that presses a nerve.

Decompression: widening a narrowing with micro instruments. The use of a special endoscope allows the surgeon to safely perform back surgery by means of an 8mm skin incision with very fine instruments. A high-definition camera allows the operation to be performed under direct view of the anatomy and thus the nerves or spinal cord, in opposition to older percutaneous techniques in which the neural structures could not be seen.

Which operations can be performed endoscopically?

Almost all lower back disorders can be treated endoscopically:

• Disk herniation

• Facet joint cyst ( Facet cyst)

• Spinal stenosis.

• Foraminal stenosis (Nerve opening narrowing)

Disk herniations: regardless of the location or size of the hernia, it can be treated endoscopically. This technique is particularly elegant for otherwise difficult to treat foraminal or extra-foraminal hernias.

Facet joint cyst or facet cyst: a benign cyst (similar to a wrist cyst) that presses on a nerve or the spinal cord can be removed.

Lateral or central recess spinal stenosis: a narrowing of the spinal canal with compressed nerve can be treated with small cutters and other special instruments.

Foraminal stenosis: a narrowing of the lateral nerve openings of the vertebrae with compressed nerve can also be widened here with small burrs and other special instruments.

What is not possible with spine endoscopy?

There are limitations to the current applications of endoscopy in the treatment of back disorders, some problems can NOT be solved endoscopically:

• Removing scar tissue from previous back surgeries

• Treat vertebral fractures.

• Spinal instability: vertebrae with abnormal mobility.

• Scoliosis, deformity of the spine

• Global spinal stenosis: multi level stenosis of "all” levels

If in the past one or more 'classic' back operations have been performed and a problem of scar tissue and chronic pain has arisen, this cannot be treated endoscopically. Removing the hard scar tissue that strangulates the soft nerves is impossible without causing an additional nerve injury. The endoscopic procedure would also cause further scarring or even additional nerve damage.  

Vertebral fractures, instability and deformity ( scoliosis) of the spine are corrected with screws and plate rods during surgery. This is not yet possible with the endoscope (with predicable results).

Due to the possible long surgery time, canal decompresion at multiple levels is not routenely performed . In case of a spinal canal narrowing at different levels, it is investigated which level is causing (most) complaints. This level is then treated first. Some times surgery is staged in two sessions. Some weeks are in between the two procedures. An endoscopic decompression of the another level may progress to a more critical stenosis, additional full endoscopic decompression may therefore prove necessary in the future. 

Evidence Based : scientifically proven benefit.

The Belgian health care knowledge centre qualifies full-endoscopic therapy as an evidence based (scientifically founded) treatment of leg pain or arm caused by pinched nerves. In the subgroup "radicular pain" (leg pain caused by nerve compression) endoscopy is recommended for surgical treatment.