Arthroscopic back surgery is a minimally invasive surgery used to treat certain problems with the spine and back. It uses smaller incisions than those seen in most traditional operations, and typically allows for a faster and easier recovery. The technique depends upon and is built around the use of an arthroscope, a thin flexible tool about the diameter of a drinking straw, that is inserted into a person’s spine through a small exterior cut in the skin and through which the surgeon can see and work. There are several different types of back surgeries that can be performed using arthroscopic techniques, though arthroscopy is not suitable for all problems and procedures.
In arthroscopic procedures, a surgeon uses a tool known as an arthroscope to first view and then ultimately repair minor problems with joints. The arthroscope is basically a small tube that is inserted into a person’s body in much the way that a catheter would be. Once in place, the surgeon can feed a small wired camera down the tube to see up close what is going on inside. Before this technique was pioneered, an up-close view of internal happenings required much more invasive surgical incisions.
Once the surgeon sees the issue, he or she can insert specialized tools down the tube to perform needed repairs or procedures. Most of these are displayed on a large screen attached to the video feed, giving the practitioner a close-up and enlarged view of what he or she is doing. These types of procedures are often really beneficial for spinal problems because they are so much less invasive than traditional back surgeries and can help people recover and get back to their daily activities a lot faster.
Herniated or Bulging Discs
Arthroscopic back surgery is perhaps most common in cases of bulging or herniated discs in the spine. These sorts of procedures, known as discectomy surgeries, involve actually removing the portion of the disc that is compressing spinal nerves. Arthroscopic discectomy procedures are quite common and generally are performed with few surgical complications.
A foramenotomy surgery using arthroscopic methods also might be considered if both bone and disc tissues are compressing spinal nerves. This procedure removes the bone and disc tissue to alleviate pain and numbness. A foramenotomy might be performed arthroscopically, but this usually depends on the amount of bone and tissue that must be removed. If the pieces can’t be broken up enough to fit through the tube, more traditional surgery might be more appropriate.
Spinal Cord Compression
When the bone and discs have deteriorated so that the spinal cord itself is being compressed, as in conditions such as spinal stenosis or spondylolisthesis, a laminectomy is usually performed, but this type of surgery isn't usually suitable for arthroscopic techniques. A laminectomy removes bone and disc tissue, much like a foramenotomy, but it is considered more serious because of the involvement of the spinal cord. For this reason, it is less common to see a laminectomy performed arthroscopically. It can be done, though much of this depends on the specifics of the patient’s condition and the surgeon’s expertise and overall comfort level.
A relatively new type of spinal surgery that allows the entire vertebral disc to be replaced with an artificial disc can be performed using arthroscopic techniques involving lasers. This sort of procedure might be performed for a variety of purposes, including a disc that has herniated multiple times or in cases of severe degenerative disc disease (DDD). Though this type of surgery is relatively cutting-edge, it is becoming more common around the world as research widens.
Limitations and Need for Continued Research
Arthroscopy isn’t appropriate for all situations. Spinal fusions are one example; these procedures are usually performed along with a laminectomy, but fusions can also be performed alone to correct spondylolisthesis. The extensive nature of this procedure usually precludes it from being performed during an arthroscopic back surgery, although new surgical methods may allow for less invasive methods in the future. The purpose of a spinal fusion is usually to prevent vertical motion of the spine so that nerves in the immediate area are not compressed. A spinal fusion often involves the use of bone grafts harvested from another part of the body, usually the hip, and the implantation of titanium rods, screws, or brackets for added stability.
In nearly all cases, the type of back surgery performed will depend largely on the underlying condition. The severity of the condition being treated will also determine whether or not an arthroscopic back surgery is possible. More severe conditions may necessitate more invasive traditional surgical techniques in which larger incisions are required.