What is endoscopic spine surgery?
Endoscopic spine surgery is an umbrella term for a group of minimally invasive techniques. Instead of a single large incision, the surgeon works through one or two small openings using an endoscope, a thin instrument with a tiny video camera on the end. The camera projects a magnified view of the spine onto a monitor, so the surgeon can see the operating site clearly without cutting through large amounts of muscle.
It is generally regarded as the least invasive form of minimally invasive spine surgery. Endoscopic techniques were first used on the spine in the 1980s, and improvements in cameras, instruments and training over the past decade have made them a well-established option in suitable cases.
The technique I use, and the one this article focuses on, is called Unilateral Biportal Endoscopic (UBE) spine surgery. Biportal simply means two portals: one small incision for the camera and a second for the surgical instruments. This setup gives the surgeon good visibility and room to work with standard instruments.
I routinely perform this surgery as a part of spinal decompression surgery here in Melbourne.
What conditions can endoscopic spine surgery treat?
Biportal endoscopic surgery is mainly used to treat nerve compression in the spine. Common conditions include:
- Disc herniation (prolapse). Part of a spinal disc bulges or breaks away and presses on a nearby nerve.
- Spinal stenosis. Narrowing of the spinal canal that squeezes the spinal cord or nerves.
- Sciatica. Sciatica is leg pain caused by a compressed nerve in the lower back, often from a herniated disc.
Symptoms that can point to these problems include persistent back or neck pain, pain radiating down a leg or arm, numbness, tingling, or weakness in the limbs. If you are experiencing any of these, see your GP for an assessment and, if needed, a specialist referral.
Who is a candidate for endoscopic spine surgery?
Suitability depends on your diagnosis, your scans and how your symptoms are affecting daily life. In general, keyhole surgery can be considered for the conditions above when symptoms persist despite non-surgical treatment. Your surgeon will assess whether it is the right approach for your specific situation.
Endoscopic surgery does have limits. Operations that involve significant implants, such as spinal fusion or disc replacement, cannot currently be performed through an endoscope and still require open techniques. That said, advances in robotic spine surgery are making these larger procedures less invasive than they once were.
How is biportal endoscopic spine surgery performed?
I use the biportal keyhole technique for lumbar decompression, microdiscectomy and laminectomy. The details differ between procedures, but the core approach is the same:
- Intraoperative X-rays are used to locate the exact level of the spine being treated and to guide the incisions.
- Two small incisions are made, each around 8mm.
- The surgical tract is gently dilated to create a stable working channel down to the spine.
- The endoscope goes in through one portal, giving a magnified view of the spine on a monitor.
- Fine microsurgical instruments go in through the second portal to remove the damaged disc material or bone pressing on the nerve.
- Once the compression is relieved, the incisions are closed with a few stitches.
Potential benefits of endoscopic spine surgery
Compared with traditional open surgery, endoscopic techniques may offer several advantages in suitable cases:
- Less tissue damage. The small incisions avoid stripping muscle away from the spine, which helps preserve normal anatomy and movement.
- Less post-operative pain. Because less tissue is disturbed, patients often report less pain after surgery.
- Minimal scarring. Two 8mm incisions leave very small scars.
- Shorter hospital stay. Many patients go home sooner than they would after open surgery.
- Less blood loss. Working through a small channel typically involves less bleeding.
- Enhanced visibility. The camera magnifies the operating site, giving the surgeon a clear, detailed view of the nerve and surrounding structures.
A 2022 systematic review found lower complication rates, smaller incisions and shorter hospital stays with the endoscopic approach, and similar overall success rates. Individual results still vary, and no technique suits every patient.
What are the risks of endoscopic spine surgery?
All spine surgery carries risk, and keyhole surgery is no exception. The risks are broadly similar to open surgery, although some occur less often. They include:
- Infection. Any surgery carries an infection risk, though smaller incisions reduce exposure.
- Nerve injury. Instruments work close to the spinal nerves, so there is a small risk of nerve damage causing numbness or weakness.
- Bleeding. Less common than in open surgery, but unexpected bleeding can still occur.
- Dural tear. A small tear in the tough membrane covering the spinal cord. Uncommon, and usually manageable, but it can extend recovery.
- Anaesthetic complications. As with any operation under anaesthesia.
- Incomplete relief or recurrence. Some patients do not get full symptom relief, and the original problem, such as a herniated disc, can recur.
A good surgeon will be happy to walk you through all of these risks as they apply to your case. Ask as many questions as you need to.
Endoscopic spine surgery recovery time
Recovery time depends on the procedure, the condition being treated and your general health. As a rough guide:
- Many patients notice an improvement in nerve symptoms soon after surgery.
- For simpler procedures such as an endoscopic discectomy, light activities can often resume within days.
- Return to normal activities typically takes a few weeks.
- Full recovery, particularly for more complex surgery, can take several months.
Your surgeon will give you a recovery plan for your specific procedure, including when to return to work, driving and exercise. Following it closely helps support a smooth recovery.
Endoscopic spine surgery FAQs
How much does endoscopic spine surgery cost?
The cost varies depending on the procedure, the hospital, your level of private health insurance cover, and fees from the surgeon, anaesthetist and any assistants. Medicare and private insurers cover part of the cost for eligible procedures, but out-of-pocket expenses differ from case to case. Before proceeding, you should receive a written estimate of fees, known as informed financial consent, so there are no surprises. If anything is unclear, ask the practice to explain it.
Is endoscopic spine surgery painful?
The surgery itself is performed under anaesthetic. Afterwards, many patients report less pain than they would following open surgery, because the smaller incisions cause less damage to muscle and soft tissue. Some post-operative discomfort is still normal and varies with the procedure and the individual. Pain relief is provided to keep you comfortable during recovery.
What is the success rate of endoscopic discectomy?
Research results are generally positive. A 2022 systematic review found that endoscopic discectomy achieved success rates similar to open discectomy, with fewer complications and shorter hospital stays. One study of 105 patients reported a success rate of 90.4% for pain relief, though as a single study without a comparison group its findings carry less weight than the pooled research above. Success rates in studies do not guarantee an individual result, and your surgeon can discuss what the evidence means for your situation.
What does biportal mean?
Biportal means the surgery is performed through two small portals rather than one. The endoscope camera goes through one portal and the surgical instruments through the other. Separating the camera from the instruments gives the surgeon more freedom of movement and allows the use of standard microsurgical instruments, rather than only tools that fit through a single narrow channel.
Making an informed decision
Endoscopic keyhole surgery is an established option for treating disc herniation, spinal stenosis and sciatica in suitable patients, with the potential for less pain and a quicker recovery than open surgery. Whether it is right for you depends on your diagnosis, your scans and your goals.
A responsible surgeon will consider all treatment options, including non-surgical ones, before recommending an operation. Use this article as a starting point, then talk it through with your GP or specialist so the decision fits your circumstances.
