Duke Health has emerged as a regional leader in endoscopic spine surgery, with spine surgeon David Huie, MD, MS, providing specialized clinical care at Duke Neurosurgery Arringdon. As a leader in endoscopic spine surgery, Huie offers the next evolution in minimally invasive spine care, now closer to patients in Morrisville and surrounding communities.

“We can now treat many complex spine conditions using minimally invasive techniques. With incisions smaller than a centimeter, tissue disruption is significantly less,” says Huie. He has completed over 150 endoscopic cases, most of which were performed as outpatient procedures with same-day discharge.

Patients benefit from shorter hospital stays, faster recovery, a reduced need for pain medication, and an overall gentler postoperative course.

For many patients presenting with sciatica or other forms of nerve compression, endoscopic procedures offer a focused solution. As Huie notes, the technique is also expanding the candidate pool: “Patients with significant comorbidities who are higher-risk surgical candidates may be better suited to an endoscopic approach.” Duke spine surgeon Muhammad M. Abd‑El‑Barr, MD, PhD, further expands options for higher-risk patients through awake endoscopic procedures, enabling those who cannot tolerate general anesthesia to receive treatment.

Importantly, endoscopic procedures can often serve as an intermediate surgical alternative for patients who have been recommended for larger, more extensive surgeries, while preserving the option for a larger operation if needed. 

“I often see patients who have been offered larger, more invasive operations by other surgeons. In many of these cases, there may be a smaller endoscopic surgery that targets the most troublesome of their symptoms. If the relief from the endoscopic operation is not enough, they can still have the larger surgery that they would have had anyway,” says Huie. “In the vast majority of cases, patients opt to try the smaller surgery first, and many improve to the point where the larger operation is not needed.”

Huie anticipates exploring new indications, the integration of navigation and robotics, and the selective use of endoscopy within larger procedures as emerging areas within the field. “I envision endoscopic spine surgery following the trajectory of arthroscopic joint surgery, where early adoption led to broad acceptance as a standard of care.”

Duke's spine program takes a collaborative, multidisciplinary approach. Recommendations for surgery often involve evaluation not only by spine surgeons, but also colleagues within specialties including physiatry, physical and occupational therapy, and neurology. Much of this evaluation and diagnostic workup can be completed at the Arringdon location, providing patients with convenient access to care.

Most patients begin with conservative management, including physical therapy, injections, and medications, and consider surgery only when those measures are insufficient. “Surgery is inherently the riskiest option for treatment, so we always want to explore non-surgical options first and then move on to the best surgical strategies, if needed,” says Huie.

Physicians considering a referral should be aware of red-flag symptoms that warrant urgent evaluation, including progressive or severe weakness, bowel or bladder dysfunction, loss of hand control, balance impairment, or other signs of significant neurologic compromise. “We are always happy to consult on a case with a referring physician and discuss how we may offer personalized solutions for their patients,” concludes Huie.