Background, techniques, applications, current trends, and future directions of minimally invasive endoscopic spine surgery: A review of literature

Abstract

Across many of the surgical specialties, the use of minimally invasive techniques that utilize indirect visualization has been increasingly replacing traditional techniques which utilize direct visualization. Arthroscopic surgery of the appendicular skeleton has evolved dramatically and become an integral part of musculoskeletal surgery over the last several decades, allowing surgeons to achieve similar or better outcomes, while reducing cost and recovery time. However, to date, the axial skeleton, with its close proximity to critical neural and vascular structures, has not adopted endoscopic techniques at as rapid of a rate. Over the past decade, increased patient demand for less invasive spine surgery combined with surgeon desire to meet these demands has driven significant evolution and innovation in endoscopic spine surgery. In addition, there has been an enormous advancement in technologies that assist in navigation and automation that help surgeons circumvent limitations of direct visualization inherent to less invasive techniques. There are currently a multitude of endoscopic techniques and approaches that can be utilized in the treatment of spine disorders, many of which are evolving rapidly. Here we present a review of the field of endoscopic spine surgery, including the background, techniques, applications, current trends, and future directions, to help providers gain a better understanding of this growing modality in spine surgery.

Keywords: Applications; Endoscopic; Endoscopy; Minimally invasive surgery; Spine; Spine Surgery.

Figure 1

Direct endoscopic view from tubular/retractor-based camera that provides a two-dimensional image on a screen with digital zoom.

Figure 2

Minimally invasive surgery endoscopic technique. A: Endoscopic cannula inserted in posterior lumbar region; B: Tubular/retractor-based setup where the camera can be inserted into the body through a channel called a working channel.

Figure 3

Direct two-dimensional endoscopic view (top of image as anatomically medial, bottom as lateral, left as cranial, and right as caudal) with dura mater exposed. A: Disc has compressed nerve ventrally; B: Disc irrigated, exposed, and removed to alleviate nerve compression; and C: Nerve has been decompressed.