The spine is the centre of the human body – this anatomical fact has significant implications both for the general public and the specialists’ surgeons managing spine disorders. From a general point of view, it means any affliction of the spine will have profound implications on the overall health of the human body and for the spine surgeon, it means dissection through a lot of healthy tissues (muscles, ligaments, bones) to reach the diseased spine. Till a few decades ago, the spine surgeons had no choice but to accept this collateral damage. The invention of the surgical microscope enabled the spine surgeons to tackle this dual menace of poor visibility deep inside the body and need for wide surgical dissection by literally enhancing a surgeon’s vision power manifold.
Although the use of microscope significantly brought down the size of skin incision, muscle dissection, and bone cutting, it was still profound and had implications on clinical outcomes. The next big thing in the field of spine surgery was the development of surgical endoscopes. Surgical endoscopes not only enhance the visual power of the surgeon but also placed the surgeon’s eyes exactly next to the diseased spine. In other words, this meant the surgeon needs soft-tissue dissection only to place the endoscopes near the surgical field. This literally translated into millimeter long skin incisions with least possible tissue damage, blood loss or any kind of collateral damage. For a spine surgery performed without the use of a microscope, the field of dissection looks like a rectangle, this changes to a cone shape (with its base at the skin) with the use of a microscope and to an inverted cone with a base at the diseased region of the spine with the use of the endoscope. This means that maximum surgical dissection takes place at the diseased region of the spine rather than at healthy tissues.
The success rate of spine surgery has come at par with well established surgical procedures like bypass surgery for heart and knee/hip replacements. For this change to happen, the technique of spine surgery has quickly evolved from mindless butchering of paraspinal tissue (in the name of surgical dissection) to careful soft-tissue preservation. This has been made possible with the advent of advanced surgical micro/endoscopes that provide unmatched illumination, magnification, and visualization.
The endoscopic spine surgery seems to be the holy grail for both spine patients and surgeons. Keeping up with Narayana healthcare’s tradition of bringing the most advanced technologies, the Spine team at Narayana Hospital, Gurugram, comprises of four experienced spine surgeons, who are extensively trained in endoscopic spine surgery techniques and have at their disposal a modular spine surgery operating suite comprising of high end ultra 4K endoscopes, 3D navigation, intra-operative CT scan and live neuromonitoring. We routinely deploy all these cutting edge technologies to give clinical results at par with (and many times better than) world standard.
The writer, Dr. Rajesh K Verma, is a Director – Orthopaedics, Joint Replacement & Spine Surgery at Narayana Superspeciality Hospital in Gurugram