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What is the Difference Between Endoscopic vs. Microscopic Spine Surgery?

If you suffer from chronic back and leg pain and have tried non-surgical treatments and interventions with no success, it is probably time to seek a surgical alternative. According to a study in the World Journal of Orthopedics, nearly 100% of adults will experience spinal problems at least once during their lifetime, and costs for treating lower back pain increased a whopping 65% between 1997 and 2005; primarily for non-surgical treatments.¹ But the study also found that, although surgical treatments are generally more expensive than non-surgical options, the overall economic impact favored a surgical alternative, which reduces time off from work and improves productivity.

Common Causes of Back Pain

Back pain can result from several common conditions. Simple muscle strain or overexertion can lead to back pain, especially if the activity is constant and repetitive. Avoiding such activities can help reduce the instances of pain, while allowing the body to heal naturally.

Other spinal conditions may be caused by aging, genetics, trauma, or disease. These include:

  •  Degenerative disc disease, where natural changes take place over time, reducing the discs' effectiveness to cushion and provide flexibility to the spine.
  •  Herniated disc, where the disc leaks fluid or bulges, putting pressure on surrounding nerves.
  •  Osteoarthritis, caused by wear and tear of the spine, where the vertebrae can grind against each other or develop bony spurs that aggravate nerves.
  •  Spinal stenosis, which results in narrowing of the nerve passages, causing pain and loss of mobility.
  •  Tumors, which put pressure on the spinal cord or surrounding nerves.

Fortunately, many of these conditions can be treated and corrected via spinal surgery, alleviating chronic pain and restoring function and mobility.

But what is the best surgical approach for treating your chronic lower back pain? Here, we'll compare two common surgical treatments for correcting back pain resulting from herniated or degenerative lumbar discs: endoscopic versus microscopic spine surgery.

Advantages of Minimally Invasive Spinal Surgery (MISS)

First, let's look at the similarities between endoscopic and microscopic spinal surgery. Both are considered minimally invasive procedures, which are performed via smaller incisions compared to traditional open spinal surgery. Minimally invasive spinal surgery (MISS) offers many advantages over conventional spinal surgery, including:

  •  Less trauma to surrounding tissues, resulting in less bleeding and faster healing
  •  Quicker recoveries, with many patients walking the same day of the surgery
  •  Reduced hospital stays, since the procedures are performed on an outpatient basis
  •  Less risk of hospital-based infection
  •  Minimal scarring
  •  Less tissue disruption can result in greater longevity of your spine

The advantages of minimally invasive procedures are apparent. By reducing the size of surgical incisions, MISS allows for a more targeted approach to correcting the underlying causes of back pain. But which minimally invasive approach is more effective: endoscopic or microscopic spinal surgery?

Microscopic over Endoscopic Spine Surgery: A Better Alternative

Although both endoscopic and microscopic surgery are minimally invasive, there are advantages to the microscopic approach that endoscopy cannot offer. During endoscopic procedures, the surgeon visualizes the interior structures of the spine via an endoscope—a small tube containing a camera that is inserted into an incision, projecting a two-dimensional view of the three-dimensional surgical site onto a monitor thus resulting in suboptimal visualization.

Microscopic back surgery is performed via high-powered microscopes that are not limited to the scope of the endoscopic camera, thereby affording a greater visual field while still minimizing disruption to the soft tissue. Furthermore, advanced optics afford the surgeon a three-dimensional view of the surgical field which allows for safer, more effective treatment of your spinal condition . Some endoscopic procedures, such as discectomy, are considered to have a higher complication rate than the microscopic technique, which is the most commonly performed treatment and considered the gold standard in disc removal ²

How Do I Find the Right Surgeon?

Choosing microscopic over endoscopic spine surgery means you will be receiving the most effective technique available to correct your underlying issue. But how do you go about finding the right surgeon for your procedure? Here are a few questions you should ask prospective surgeons to help you identify the best physician for the job.

  •  “Are you board certified in spinal surgery?” Board certification ensures your doctor has the appropriate education, training, and experience to perform spinal procedures.
  •  “Do you specialize in microscopic, minimally invasive procedures?” Just like board certification, you want someone who has the proper training and experience in microscopic techniques.
  •  “How many procedures have you performed?” Go with experience—someone who has a solid reputation in microscopic MISS.
  •  “What are the risks and complications of my procedure?” A specialist will be able to inform you about all the risks and possible complications of MISS.
  •  “What can I do to prepare for my procedure?” Your surgeon can recommend ways to improve your outcome and reduce the chance of complications by making lifestyle changes, such as exercising, dieting, and stopping smoking.
  •  “What will my recovery entail?” Your surgeon should not only perform your procedure, but guide you throughout your recovery by providing a comprehensive plan at an integrated facility. This should include a state-of-the-art surgical center, qualified physical therapists to get you back on your feet, and a range of treatment options that will return you to your active lifestyle.

If it's time for you to consider surgery to alleviate your chronic back pain, be sure to choose the most effective procedure, a qualified surgeon, and an integrated facility that will see you through your recovery.


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¹ Hofstetter, Christopher P., Anna S. Hofer, and Michael Y. Wang. “Economic Impact of Minimally Invasive Lumbar Surgery,” World Journal of Orthopedics, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4363801/

² “Endoscopic Discectomy and Microdiscectomy for Lumbar Herniated Discs,” Spine-Health.com, 2018, www.spine-health.com/ask-a-doctor/herniated-disc/endoscopic-discectomy-and-microdiscectomy-lumbar-herniated-discs

Robert S. Bray, Jr., M.D.

About the author

Robert S. Bray, Jr., M.D. Nicknamed “Dr. Fix-It” by The Red Bulletin, Robert S. Bray, Jr., M.D. makes an art of helping the world’s most elite athletes return to push the boundaries of performance. The neurological spine surgeon, recognized globally for his thorough diagnoses and pioneering minimally invasive approach, is quickly redefining sports medicine, one champion at a time. Dr. Bray founded the state-of-the-art, multi-disciplinary DISC Sports & Spine Center (DISC) in 2006 located in Los Angeles, CA. Read more articles by Robert S. Bray, Jr., M.D..

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