May 25, 2021

Understanding the benefits of endoscopic surgery

Nearly everyone will experience back pain at some point in their lives. In most cases, an acute case of back pain will resolve itself in a couple of weeks or less. But sometimes back pain can radiate into the legs and be the result of something more serious that may require treatment or even surgical intervention. Endoscopic surgery is a minimally invasive option.

If you are considering spine surgery, you may be wondering about the benefits of endoscopic surgery. We asked Raymond Gardocki, M.D., of Vanderbilt Orthopaedics, to explain the advantages of this minimally invasive method.

Who is a candidate?

“Ideally for an endoscopic candidate,” Gardocki said, “we would want to pinpoint one anatomic location down to one or two nerves that are symptomatic. You have to do a very detailed history and a very detailed physical exam. Sometimes we will do diagnostic injections to help confirm that one specific location is the major source of pain. For patients with more global spinal issues, such as scoliosis, severe diffuse arthritis, or sagittal or coronal imbalance, endoscopic spine surgery may not be the right fit.”

Less invasive than traditional spine surgery

“In traditional spine surgery,” Gardocki said, “patients are often recovering from the surgical approach.” That’s because a large incision is made and then muscles need to be peeled off the spine and held back under pressure with a retractor. But with endoscopic surgery, “the endoscopes are essentially inserted into the spine like a large needle,” he explained.

The pencil-sized endoscope is inserted into a cannula, so that your surgeon can view and operate on a targeted area without harming surrounding tissue. “The recovery then is based on the underlying issue, not the surgical approach,” Gardocki added.

Additionally, with endoscopic spine surgery, only the specific tissue that needs to be removed has to be removed. “We can spare more of the joints, the muscles and ligamentous structures,” Gardocki explained. “So you’re less likely to get instability, which is abnormal motion of the spine that can cause nerve compression symptoms.”

Reduces reliance on pain medications

Although every situation is different, Gardocki said many patients undergoing endoscopic spine surgery don’t require narcotic pain medications during recovery. “Narcotics are a big issue in the Mid-South,” he explained. “And oftentimes people get hooked on them, starting with pain medication prescribed for a surgery. So if you can avoid that, that’s a major advantage.”

May not require general anesthesia

Endoscopic spine surgery can usually be performed as an outpatient procedure and often without general anesthesia. General anesthesia requires the use of a breathing tube and a deep state of sedation. “There are some issues and complications that can come just from the anesthesia, like delirium, nausea, vomiting and urinary retention,” Gardocki explained. So when a procedure can be performed without general anesthesia, it reduces certain associated risks.

“With the endoscope,” Gardocki said, “you can sometimes do this under what we call conscious sedation.” With conscious sedation, a patient is sleepy, but they’re breathing on their own and they can respond if asked a question.

“The beauty of that is the patient can respond to things that are painful,” Gardocki said. “They’ll tell us if we’re putting too much pressure on a nerve.” But they typically won’t remember much about the procedure when it’s over, he added.

Help in Franklin

Vanderbilt Orthopaedics clinic in Franklin is taking new patients who seek relief from pain and conditions involving the spine. We also treat injuries and chronic pain of the bone, muscle and joint. Dr. Gardocki is the only surgeon in the Nashville area who’s trained to perform endoscopic spine surgery. We’ll help you get back to doing the things you love, pain-free.

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