Endoscopic spine surgery, also called laser spine surgery by the public, is spine surgery done through a small endoscope. The endoscope allows direct visualization of the surgery on the spine without large skin incisions, muscle retraction, bone removal, pain and general anesthesia. Initially, it was used to treat small, contained disk prolapses, but with improvement in endoscopes, surgical equipment and techniques this technique expanded to treat most spinal disorders.
Endoscopic spine surgery developed out of the clinical and laboratory research of Dr. Parviz Kambin in the early 1970’s in Philadelphia, PA. His initial work was the removal of the nucleus pulposus, which is the soft, gel-like material in the center of a lumbar disk. Dr. Kambin studied the anatomy of the disk and defined a safe zone into the disk which was later named Kambin’s triangle. This triangle is free of critical structures and is surrounded by the exiting nerve root, traversing nerve root and the inferior vertebral body margin. It allows safe passage into the disk for removal of the nucleus pulposus. Dr. Kambin also developed a percutaneous surgical instrument set to remove the disk under x-ray guidance. The disk or spine could not be directly visualized.
In 1989, Dr Schreiber was first to place an arthroscope into the disk to directly visualize the disk material.
In the 1990’s, Dr. Anthony Yeung developed the first spinal arthroscope (“YESS”) spine endoscope. He was largely responsible for the popularization of endoscopic spine surgery. Dr. Yeung developed the “Inside Out” technique. The endoscope was placed into the disk space to remove the nucleus pulposus and then the endoscope was pulled out of the disk space to remove any disk material in the foramen.
Thomas Hoogland developed a set of endoscopic instruments which included trephines or reamers to enlarge the lumbar in 1994. He later worked with MEDI-Tech and then JOIMAX to produce the THESSYS system. This revolutionary system allowed the surgeon to open up the foramen to provide direct access into the spinal canal. This was called the “Outside In” technique because you started outside of the disk and then moved into the disk as needed. Endoscopic spine surgery was no longer limited to working inside the disk and the foramen. This new access allowed visualization of the nerves and spinal canal for the removal of disk herniations that move outside of the disk wall (annulus fibrosis), permitting “traditional” spine surgery to be done through the endoscope.
JOIMAX continued to refine and develop these techniques which were later renamed TESSYS after Dr. Hoogland left the company. The surgical techniques continue to grow and expand with the development of new power drills, endoscopes and other surgical equipment. This continued innovation and development by JOIMAX is exciting, considering most areas of spine surgery development have a plateau.
Dr. Carl Spivak is the president of Executive Spine Surgery in Hackettstown, NJ, and a board-certified neurosurgeon. He is recognized worldwide for his expertise in innovative, noninvasive and state-of-the-art endoscopic spinal surgery.