Samuel Cho, MD, left, reviews a patient’s surgical plan with Brian Cho, MD, MSCR, a member of the care team.
Patients with pain in their spine or spine-related leg pain are often first counseled to try conservative treatment options like physical therapy or lifestyle modifications. However, when the pain persists, they may need surgery.
For many of these patients, an ultra-minimally invasive method called bi-portal endoscopic spine surgery is a worthwhile alternative. It is particularly useful for patients with a herniated disc, spinal stenosis (a narrowing of the spine), or spondylolisthesis (a condition in which a vertebrae moves out of place). It’s also a practical alternative to conventional open surgery—which typically involves making a larger incision—especially for frail patients and others who may not tolerate an open procedure.
“Due to a smaller incision and less disruption to the muscles and ligaments surrounding the spine, there is less pain, less bleeding, and a reduced risk of infection,” says Samuel Cho, MD, Chief of Spine Surgery, Mount Sinai West. “With endoscopic spine surgery, patients are able to get out of bed and begin physical therapy much sooner after surgery. All of these factors lead to a shorter recovery period with low complication rates and decreased potential for long-term instability.”
Biportal endoscopic spine surgery uses two independent, exchangeable portals for viewing and working through two incisions about a quarter of an inch to a third of an inch in size. With this technique, surgeons maintain a certain distance from the bony and neural structures, which allows closer access to the target lesion through a magnified, panoramic view that supports accuracy and precision.
Through one portal, which is one of the incisions, a thin fiber-optic video camera is inserted into the body, allowing the surgeon to use one portal for viewing and the other portal, through the other incision, for working. These can be exchanged as needed to maximize the outcome of the surgery.
“By using this technique all of the normal structures are preserved,” says Dr. Cho. “At the end of the procedure, the endoscope is removed and only a small bandage is needed to cover the incision area.”
“To date, I have performed over 50 spine surgeries using bi-portal endoscopy with very positive outcomes,” says Dr. Cho.
Others with special circumstances or special needs may also benefit from this ultra-minimally invasive approach, according to Dr. Cho.
For example, one patient had a metastatic tumor causing loss of bowel and bladder function, which is considered a surgical emergency; however conventional surgery is not recommended for patients needing chemotherapy and/or radiation due to the possibility of the closed incision reopening or infection. With endoscopic surgery, the incision is extremely small so patients can receive radiation right away after surgery. In this case, Dr. Cho performed an endoscopic procedure and the patient’s nerve function, along with bowel and bladder function, returned immediately.
As Chief of Spinal Deformity for Mount Sinai Health System, Dr. Cho sees many patients with scoliosis, a curvature of the spine. One scoliosis patient was experiencing spinal stenosis. Traditional open surgery can potentially disturb enough of the surrounding structures to make scoliosis worse following decompression surgery. Damage to surrounding structures is avoided with an endoscopic approach. This patient had a positive outcome avoided the need for a major surgery.