Mark Mahan, MD, a spine and peripheral nerve surgeon, made a radical departure from traditional, open spine surgeries about 8 years ago.
“I was performing minimally invasive spine surgeries, but felt that they weren’t nearly minimally invasive enough,” Dr. Mahan shared. “The 16- to 26-millimeter-diameter tubular retractors we used for surgery were large enough that outcomes were not substantially different whether a patient underwent minimally invasive or open surgery.”
At that time in the US, there were only a handful of surgeons who used an endoscope for spine surgery, so, Dr. Mahan traveled to learn the process from the few who were. He and others have adopted a much smaller, 7-millimeter-diameter endoscope to do most of the same surgeries that have traditionally been performed with an open technique. In the process, Dr. Mahan has become one of the leaders of the developing endoscopic spine surgery revolution in the US.
The structure of the endoscope yields advantages. For example, there is a prism on the end that allows surgeons to see around corners (something that is not possible when performing open surgery). Endoscopic surgeries are not considered “open” because there is constant irrigation via intravenous fluids, which leads to substantial benefits—little to no circulating air enters deep structures of the spine, reducing infections, dural tears, and spinal fluid leaks.
Not only does endoscopic surgery require a smaller incision than open surgery, but the use of the endoscope also lessens trauma to the bones and muscles by using pre-existing openings that allow for easier access to the spine. In other words, the endoscope
has allowed novel approaches to the spine.
Since the introduction of endoscopic spine surgery, Dr. Mahan has studied the effect of endoscopic spine surgery on patient recovery. “The results have been incredible: 7 times less tissue is displaced, meaning that patients typically experience less hospital time, less muscle breakdown, and less infection. There is still some trauma associated with minimally invasive surgery, but it has been so minimized that patients can often leave the surgery center within hours with minimal pain,” Dr. Mahan said.
Last year, Dr. Mahan and several of his colleagues performed a retrospective review comparing infection rates in patients undergoing endoscopic spine surgery with those undergoing open spine surgery. They found that patients who underwent endoscopic surgery had
a lower likelihood of developing surgical site infection after the surgery. This is, in part, because of the continuous flow of IV fluid patients receive during the procedure that keeps air out of the incision.
Although there are substantial benefits to endoscopic spine surgery, it’s not surprising that spine surgery was one of the last areas in medicine to adopt endoscopic techniques. The late adoption is partially attributable to the difficulty and high number of technical requirements. The training doctors undergo is very demanding and the equipment needed can be expensive, which means that there are still relatively few spine surgeons who perform these procedures.
“Most importantly, endoscopic spine surgery offers patients better outcomes. I also enjoy the challenge of learning and performing more difficult procedures,” Dr. Mahan shared. Because these surgeries are more technically challenging to perform and require both new approaches and new skills, he is among the few
surgeons who have made the switch and among the first to do so in the Mountain West.
“There are so many technical innovations to come,” Dr. Mahan said. “Every day the field is getting better and stronger, and there are more technical resources. There will soon be options that we have barely started to conceive of.”