Ultra-minimally invasive surgery
Endoscopic spine surgery
A camera the width of a pencil, an incision the size of a dime, and, for the right problem, relief comparable to open surgery. For a herniated disc, stenosis, a pinched nerve in the neck, a thoracic disc, or facet pain, most patients go home the same day.
What it is
Spine surgery has become steadily smaller: from open operations, to the microscope, to tubes, and now to the endoscope. An endoscope is a slim camera with a working channel. It is passed to the spine through a tube about the width of a drinking straw, under a steady flow of saline that keeps the view clear. The surgeon watches a magnified picture from inside the body on a large screen and works through the same tube.
Because the tube spreads the muscle fibers instead of cutting them, and because little or no bone is removed, the back is far less sore afterward. The nerve is freed exactly as it would be in open surgery. That is the whole idea: change the path to the problem, not what is done when you get there.
Dr. Wey trained in full-endoscopic spine surgery during his fellowship at the University of Pennsylvania and uses it whenever it fits the problem. When it does not, he says so, and uses the microscope or an open operation instead.
What it can treat
Each short animation shows how the procedure works. Each guide can be printed or read in full.
Animation: Arthrex (YouTube)Watch on YouTube (opens in a new tab) Herniated disc in the low back
Endoscopic lumbar discectomy
Removes the disc fragment pressing on a nerve through an 8 mm incision, from the back (interlaminar) or the side (transforaminal). Same-day discharge.
Read the guideAnimation: Arthrex (YouTube)Watch on YouTube (opens in a new tab) Spinal stenosis
Endoscopic lumbar decompression
Opens a narrowed canal on both sides from one small opening, leaving the midline bone, joints, and muscles in place.
Read the guideAnimation: Arthrex (YouTube)Watch on YouTube (opens in a new tab) Pinched nerve in the neck
Posterior cervical endoscopic foraminotomy
Frees the nerve from the back of the neck through a 1 cm incision. No fusion, no implant, and the neck keeps its motion.
Read the guideAnimation: Arthrex (YouTube)Watch on YouTube (opens in a new tab) Herniated disc in the mid-back
Thoracic endoscopic discectomy
Reaches a thoracic disc from the side without entering the chest or moving the spinal cord, replacing much larger open operations.
Read the guideAnimation: Arthrex (YouTube)Watch on YouTube (opens in a new tab) Facet joint back pain
Endoscopic medial branch transection
Finds and cuts the small nerve that carries pain from a worn facet joint, under direct vision. An option when radiofrequency ablation keeps wearing off.
Read the guide
Compared with open or microscopic surgery
An incision the size of a dime
About 8 to 10 millimeters. The camera is the width of a pencil and works inside a tube that spreads the muscle fibers instead of cutting them.
An easier first few weeks
Published studies suggest advantages in incision size, wound-related complications, and early recovery. Outcomes vary by procedure and by patient.
Comparable relief
For appropriately selected patients, endoscopic lumbar discectomy can provide pain relief comparable to traditional microdiscectomy. The endoscope changes the path, not what is done inside.
Nothing fused, nothing implanted
The spine keeps its motion. For a pinched nerve in the neck, that means avoiding a fusion or an implant entirely.
The honest trade-offs: more X-ray is used during surgery, the transforaminal route can leave a tingly leg for a few days to weeks, and the technique has a real learning curve, so results depend on training and case selection as much as on the instrument. Open and microscopic surgery remain the right choice for some problems.
Am I a candidate?
These are general guides. Dr. Wey decides with you after an exam, a review of your history, and a careful look at your imaging.
Often a good fit
- A herniated disc with leg or arm pain that has not settled with non-surgical care, or that is causing weakness
- Spinal stenosis at one or two levels with leg symptoms when standing or walking
- A pinched nerve in the neck from a fragment or spur toward the side of the canal, with a stable neck
- A thoracic disc herniation sitting off to one side
- Facet joint pain proven by a numbing injection, especially after radiofrequency ablation has worn off
Usually not the right choice
- An unstable or slipped spine that needs a fusion
- Pressure on the spinal cord in the neck (myelopathy) or a large central neck herniation
- Severe narrowing at many levels, a large curve, infection, tumor, or a fracture
- Some large, calcified, or far-traveled fragments, which are safer with the microscope
- A nerve emergency, which needs urgent open surgery rather than a scheduled procedure
If an endoscopic procedure is not right for you, other options can still help.
What to expect
1Before surgery
- A full visit: your history, an exam, and a careful look at your MRI, and for some procedures a CT scan.
- The procedure is chosen for your anatomy, and I explain why that route and not another.
- Most endoscopic procedures are done at an outpatient surgery center.
2During surgery
- General anesthesia or sedation, depending on the procedure. Some transforaminal cases are done with you lightly sedated.
- X-ray guides a thin needle, then a tube the width of a straw, to the exact spot.
- The endoscope shows the nerve and the problem on a large screen, under a steady flow of saline. The work is done through the tube.
- Nerve monitoring runs throughout. One level usually takes under an hour.
3After surgery
- Walking within an hour or two. Home the same day for most people.
- Little or no opioid medicine for most patients.
- Desk work in one to two weeks. Physical work in four to six weeks.
- The same four weeks of no bending, lifting, or twisting as any disc surgery: the tissue heals at the same speed no matter how small the incision.
Your post-op playbook, After lumbar decompression or endoscopic surgery, covers the first six weeks day by day.
Find out if this is right for you
Bring your MRI and X-rays to your first visit. Office (201) 836-1663