Endoscopic Spine Surgery
Endoscopic Spine Surgery or ESS is the most advanced surgical treatment for spinal cord
injury. It is the most efficient and commonly performed minimally invasive surgical
procedure done with the smallest tubes, in the range of 3mm-10mm, and incisions,
depending upon the extent of the affected area.
It has a quicker recovery time and less recurring pain as compared to traditional spine
surgery methods. However, it is only done in severe or chronic conditions. It is considered
the last line of treatment for spinal complications because of the high degree of
specialization required and the sensitivity of the area it is operated on.
Depending upon the type of spine complication, different endoscopic techniques are used
to provide desired and effective results. Various endoscopic procedures which are
commonly performed are:
- Endoscopic spine decompression In this procedure, a lump or structure causing pressure on the spine is removed.
- Fusion In this procedure, the stability of the spine is restored by fusing two or more
vertebrae into a single entity.
- Disc replacement Under such a procedure, a prosthetic disc is implanted in place of the painful or damaged disc, providing relief.
- Rhizotomy In this procedure, pain-producing sensory nerves are surgically severed to curb the
- Foraminotomy It is a surgical procedure in which the pressure on the compressed nerve is relieved by enlarging the area around one of the vertebrae.
- Discectomy Endoscopic discectomy is performed to treat the problems of back and leg pain
caused by a herniated disc.
- Balloon kyphoplasty This kind of surgery is done to treat spinal fractures caused by conditions like osteoporosis.
Signs & conditions which indicate the need for ESS
ESS is the last step in the treatment of spinal disorders and is usually done after the non-success of physical therapy & medications. Some of the major spine conditions which call for ESS surgery are:
● Moderate to severe disc herniation
● Facet arthropathy
● Spinal canal stenosis
● Degenerative spine disease
● Annular tears or ruptures, anywhere around the spine
● Failed back syndrome
● Inflammation between the in-vertebral discs of the spine
● Spinal tumour
● Adjacent level disease after spine fixation
1. Medical risk to patients (with old age or certain conditions) because of the use of
2. Chances of developing pneumonia, post-surgery
3. Risks of developing pulmonary embolus because of the development of blood clots.
4. Excessive or severe blood loss in some cases
5. Irritation in surrounding tissue
6. Post-surgery complications like fever, severe pain, severe headache, and trouble
7. Injury to the adjacent tissue or nerves that might lead to paralysis in some cases
8. Sometimes, the operated area may develop certain infections. So, careful monitoring
of the surgical site should be done.
9. It should not be performed in cases of scoliosis, spinal instability, cancer, or tumour.
● Less traumatic as it incorporates smaller incisions, causing less damage to adjacent
● Less painful compared to open surgeries.
● Time-efficient; surgery gets completed in less than an hour.
● The risks associated with post-surgical infections are minimal.
● Faster recovery and reduced blood loss
How is ESS executed
ESS is a critical and delicate treatment that must be delivered with utmost precision. Listed
below is the step-by-step process of its execution:
1. For ESS, the patient is first prepared for surgery by providing anaesthesia, either
locally or regionally.
2. An incision of 1 inch or smaller is made and a tubular trocar is inserted.
3. The spine is approached either intralaminar, from the back of the spine between two
laminae, or transform lamina (from the back/side of the spine into the
neuroforamen) depending upon the patient’s diagnosis.
4. After that, a tiny camera is inserted through the trocar into the affected area.
5. This camera projects the inner images for the surgeon’s view of the operating site.
6. It assists & guides the surgeon throughout the surgery.
7. On completion of the surgery, the camera & tubular trocar are gently removed & the
incision is closed using a small dressing, such as a band-aid, etc.
Postoperative care & measures
Since ESS constitutes a minimal amount of tissue injury and trauma, the patient is allowed to go home the same day.
However, depending on the patient's condition, the patient may be required to stay for several hours or even a day or two for observation. Painkillers are prescribed to patients for relieving pain after surgery. The patient can resume a healthy and normal diet as soon as s/he wishes.
Some of the things that need to be taken care of are:
● No heavy weightlifting or bending till full recovery
● Wearing a back brace for a prescribed time
● Physical therapy and massages are recommended to strengthen the muscles around the treated area
● Regular check-ups and follow-ups should be done with the doctor for a safer and quicker recovery
Factors affecting the success rate of ESS
The severity of pain and symptoms
Initial stages of injury or newborn pain or symptoms are more likely to be treated
successfully when compared to chronic & archaic conditions.
● Patient’s lifestyle
An active & healthy lifestyle aids the success rate of surgery.
Surgery may not prove to be as successful in people with excessive weight. This is
because they are more likely to face lower back or leg pain issues due to increased
strain on the muscles.
● Smoking habits
Smoking habits or excessive tobacco use may interfere with a patient's early
recovery. This is because they slow down the healing process and therefore
indirectly affect surgery recovery.
ESS is quite a risky procedure as it involves the most sensitive area of our body & any
damage to it can lead to drastic and atrocious effects. Therefore, precise diagnosis,
sophisticated equipment & spine surgical expertise are required for its success.
Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad provides state-of-the-art equipment & technologies. Additionally, a team of professionals with advanced laboratories & pathology services provide patients with a precise analysis of their conditions &
treatments. As spinal injury and its treatments carry a lot of potential dangers & risks, an
expert opinion or consultation is a must before taking any step at the initial stages.
Dr Puneet Malik is the best Brain, Spine, and Nerve Expert in Delhi NCR. An expert and a neurosurgeon with 10+ years of experience, he has treated a huge number of patients successfully to date.