Duke Health continues to advance spine surgery with minimally invasive procedures, including robotic, tubular, and endoscopic approaches. Endoscopic surgery, which can be performed as an outpatient procedure, in particular helps patients return to the activities of daily life faster, according to spine neurosurgeon David Huie, MD, MS. “With lower postoperative pain and quicker ambulation, patients can get up and get back to their lives faster. The recovery process doesn’t take as long,” he says.

Endoscopic spine surgery uses small incisions of about 1 cm to insert a camera and instruments into the spine. The procedure is most commonly used for decompression procedures with conditions including herniated discs, pinched nerves, and spinal stenosis, but indications for endoscopic procedures are always expanding. Endoscopy is also used for awake spine surgery by Duke neurosurgeons including spine surgeon Muhammad M. Abd-El-Barr, MD, PhD.

Duke Health’s spine neurosurgery team uses cutting-edge approaches to minimize patients’ pain and maximize surgical effectiveness. The team is also looking at new ways to use endoscopic surgery. “The techniques and surgical indications are growing,” says Huie. “Within endoscopic, one part has been performing less invasive versions of the surgeries we’ve already been doing, while another is utilizing the endoscope to perform operations that we were previously unable to do. The small size of the endoscope allows us to access areas of the spine that were previously more difficult or impossible to get to.”

Some aspects of surgery are currently considered too large for endoscopy. Procedures involving large portions of the back would take prohibitively long with present endoscopic techniques, but Huie anticipates a future where parts of those procedures could be done endoscopically. “Addressing problems such as deformity and oncology are some of the next things the field is working on,” says Huie.

Endoscopic spine surgery is only offered at a few advanced centers in the country. The expertise required to perform the surgery takes years of training, but Duke Health has multiple experienced endoscopic spine surgeons.

The decision to refer can be difficult. MRIs frequently aid surgeons in making a diagnosis, and Duke Health’s physicians are willing to consult with providers considering referral. “If there are any concerning imaging findings or symptoms, we’re happy to help,” says Huie. “We can look at imaging and determine whether they should see a nonsurgical provider first.”