Endoscopic Spine Surgery Program

Experts at the Endoscopic Spine Surgery Program, a part of NYU Langone&#;s Spine Center, offer a groundbreaking approach to care of the neck and lower back. Using an endoscope&#;a narrow tube with a light and high-definition camera on the end&#;our surgeons can see the inside of the body on a screen in real time, which helps them perform highly precise spine surgery. This ultra-minimally invasive approach requires only one or two small incisions.

You will get efficient and thoughtful service from Lingchuang Yihui.

Your Spine: An Operator&#;s Manual

Everything you need to know about staying nimble and pain-free from our top-ranked spine experts.

View the Book

The Benefits of Endoscopic Spine Surgery

Endoscopic spine surgery allows our surgeons to protect the surrounding tissues and structures of the spine. The surgery is safe and effective, restoring function and relieving pain from conditions such as degenerative disc disease or herniated disc.

This type of surgery is similar to knee or shoulder arthroscopy. It is typically done on an outpatient basis, meaning you can go home the same day. Recovery time, ranging from one to two weeks, is faster than with open surgery, and you can quickly return to your daily activities, improving your quality of life.

Our Surgical Expertise

Our knowledge of the latest endoscopic treatments reflects NYU Langone&#;s excellence and innovation in spine surgery. While most endoscopic spine surgeries use a single incision, several of our surgeons specialize in a more advanced procedure&#;biportal endoscopic surgery&#;which uses two tiny incisions, less than one centimeter long. This procedure is only available at a few other medical centers in the United States.

Biportal endoscopic surgery allows surgeons to use one incision for the endoscope and the other for the surgical instruments. This two-portal approach further improves surgical precision and protects the spine and surrounding tissues.

Our Supportive, Team-Based Approach to Care

In addition to our surgical expertise, our team of specialists provides you with the support you need as you make important treatment decisions about your spine health.

Orthopedic and neurosurgery spine surgeons, rehabilitation doctors, pain management physicians, neurologists, advanced practice providers, and registered nurses work together to listen to your concerns and provide you with personalized care before, during, and after spine surgery. Physical and occupational therapists may also be a part of the care plan.

Spine Conditions We Treat

Our doctors can help determine whether you are a candidate for endoscopic spine surgery. We typically use this surgery to treat conditions of the lower back or lumbar spine, including these:

The company is the world’s best spine endoscope implant pusher supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.

• degenerative disc disease
• herniated disc
• spinal stenosis
• spondylolisthesis
• radiculopathy, which is pinching of the nerve near the root
• sciatica, or injury of the sciatic nerve that originates in the lower spine

We may also use endoscopic spine surgery for conditions in the neck or cervical spine, such as disc degeneration, spinal stenosis, or a herniated disc.

Endoscopic Spine Surgeries We Perform

Our doctors may recommend one of the following surgeries as part of your spine care plan: 

• endoscopic microdiscectomy: removes a piece of herniated disc or can relieve pain caused by radiculopathy or sciatica
• endoscopic laminectomy or decompression: removes a portion of the lamina, which is the bony arch of the vertebra, to treat spinal stenosis
• endoscopic fusion: connects bones of the spine to stabilize it to treat spondylolisthesis, severe disc degeneration, or herniated disc

Our endoscopic spine surgery program leads the way in creating treatment guidelines that ensure the safe and responsible use of new endoscopic techniques for spine surgery. This work enables us to provide the highest quality of care and the best possible outcomes for our patients.

Endoscopic spine surgery is an evolving subset of MIS surgery with ever-growing indications [ 7 ]. Over the last four decades, there has been tremendous development in the field of endoscopic spine surgery. Endoscopic techniques have evolved from the earlier attempts of percutaneous nucleotomy to modern techniques of full endoscopy and biportal endoscopic decompression. With the development of specialized instrumentation and high-resolution imaging, endoscopic spine surgery, initially limited to lumbar discectomies, can now be used to treat a wide range of spinal pathologies such as spinal stenosis, instability, thoracic and cervical myelopathy, infections, intradural tumors, etc. [ 8 10 ].

With advancements in medical care and increased life expectancy of the aging population, the global burden of spinal disease has increased [ 1 ]. Spine-related disorders significantly affect the quality of life (QOL) and ability to perform daily living activities among the elderly [ 2 ]. Elderly patients with spinal disorders often suffer from numerous comorbidities and medical problems, further complicating surgical treatment and functional outcomes [ 1 4 ]. In an attempt to decrease the morbidity associated with conventional open spine surgery, numerous advances have been made in the field of minimally invasive spine (MIS) surgery. MIS surgery has several advantages, such as minimal soft tissue trauma, lesser blood loss, decreased infection rates, earlier rehabilitation, shorter hospital stays, and better functional outcomes [ 5 ]. Despite these advantages, the long learning curve, the need for special instruments and types of equipment, high costs, lack of tactile sensation and biplanar imaging, some complications that are hard to treat, and more radiation to the surgeon and surgical team are the disadvantages of MIS surgery [ 6 ].

2. Evolution of Endoscopic Techniques for Spine Surgery (Table 1)

The earliest account of percutaneous decompression techniques dates back to Kambin in and Hijikata in , who described their technique of percutaneous nucleotomy, which was an indirect non-visualized decompression through the postero-lateral approach using fluoroscopy. Kambin used a Craig cannula (5.5 mm), and Hijikata used a 2.6 mm cannula, respectively [ 11 12 ]. The next advancement to percutaneous nucleotomy was the addition of endoscopes, and in , Kambin described his technique of percutaneous arthroscopic discectomy [ 13 ]. Subsequently, in , he described a triangular safe zone bordered by the exiting root anteriorly, the traversing root medially, and the superior endplate of the lower lumbar vertebra inferiorly [ 14 ]. The description of this radiographic safe working zone allowed the introduction of larger instruments and working channels in closer proximity to the foraminal pathology without injuring the nerve root and thus led to further advancements in the field of endoscopic spine surgery.

In , Foley described the technique of micro-endoscopic discectomy, which is one of the most popular techniques in discectomy. He used a 25-degree scope through a 16 mm tubular retractor to achieve decompression for far lateral disc herniation [ 15 16 ]. In the same year, Destandau&#;s Endospine technique was introduced by Dr J. Destandau, based on the principle of laparoscopic triangulation between an endoscope and suction with a working instrument. The system is composed of three tubes: one for the endoscope, one for aspiration, and the largest one for standard surgical instruments [ 17 18 ]. In the s, Yeung developed an operating spine scope with a working channel and introduced beveled and slotted cannulas and, subsequently, allowed for direct visualization and surgical removal of disc material and foraminal decompression (foraminoplasty) through a single port [ 19 20 ]. They called their technique the &#;inside-out technique&#; of endoscopic spine surgery, where the working cannula was placed inside the intervertebral disc [ 21 ]. Subsequently, in an attempt to avoid irritation of the nerve root in cases of foraminal stenosis, Thomas Hoogland described the &#;outside-in technique&#;, where the working cannula was placed in the neural foramen after widening it using reamers [ 22 ].

Even though transforaminal endoscopic techniques were popular, there were several technical challenges for transforaminal access at the L5-S1 level owing to anatomical constraints such as high iliac crest, large L5 transverse process, large facet, narrow disc space, and neural foramen [ 23 24 ]. In an attempt to overcome these technical difficulties, Choi et al. described the technique of percutaneous endoscopic interlaminar discectomy using a rigid working-channel endoscope [ 25 ]. Irrespective of the technique used, the above endoscopic spine surgeries are performed through a single incision involving a light source, irrigation, and instrumentation. Despite the use of superior imaging, visualization is restricted, and technical difficulties may be encountered by surgeons, which are of relevance in severely stenotic canals or in cases requiring bilateral decompression [ 26 ]. Unilateral biportal endoscopic spinal surgery (UBE) or percutaneous biportal endoscopic decompression (PBED) is the combination of integrated open and endoscopic spinal surgery, which can lessen the impact of the limitations [ 27 ]. Unlike other endoscopic techniques, this technique utilizes 2 independent portals, one for the introduction of the endoscope and the other for the introduction of surgical instruments.

Table 1. Historical evolution of endoscopic technique.

Table 1. Historical evolution of endoscopic technique.

For more spinal surgery osteotomes for ubeinformation, please contact us. We will provide professional answers.

YearAuthorTechnique DescribedKambin [11]Percutaneous nucleotomy with Craig cannula (5 mm)
Fluoroscopy guided without visualizationHijikata [12]Percutaneous nucleotomy (2.6 mm cannula)
Fluoroscopy guided without visualizationKambin [13]Percutaneous arthroscopic discectomy Foley [15]Micro-endoscopic discectomy Yeung [19]YESS&#;inside-out techniqueDestandau [17]Destandau&#;s Endospine TechniqueHoogland [22]Transforaminal Endoscopy&#;Outside-in techniqueChoi [25]Interlaminar approach for L5-S1 levelEum et al. [27]Unilateral Biportal Endoscopy (UBE)/Percutaneous Biportal Endoscopic Decompression (PBED)