Surgeons use many different techniques to operate on the spine and see a patient’s internal anatomy. During an endoscopic spine surgery, both the operation and visualization are done through a small incision in the patient’s skin.
In this guide, you’ll learn all about why being able to see clearly during surgery is important. While it’s especially critical during spinal procedures, there no denying the fact that visualization is a good thing to have any time a person is being operated on! Understanding how this process works is a lot easier if you think about how a camera produces images. Obviously, you need light. Ever try taking a picture in the dark without your flash?
During any procedure, the surgeon has two ways to see a given problem. The first (and most ideal) is the direct method. You’re able to focus your eyes directly on an object, without any obstructions. Due to sterilization procedures, this is not always as easy as it seems. First, you cannot stick your face directly into the area that’s being operated on; a little distance between the surgeon and the patient is necessary. Second, the instruments being used must be covered with a protective (and sterile) sheet of plastic. When the body part that’s being operated on is large, these nuances don’t make much difference. With smaller anatomy, these precautions can hinder the surgeons ability to see clearly. Resolution can be increased (from 2.5-40x magnification, depending on the equipment). Clearly, the larger the instruments are, the larger the incision must be.
The second (and much more likely) way is considered indirect. With this method, a different approach is taken. A surgeon can use a spinal endoscope, which is a small flexible tube equipped with a camera lens. The scope is tiny, so can get closer to the area of interest. Importantly, this let’s surgeons see objects even when they are obstructed by surrounding tissues/structures. It too, has magnification capabilities. High-definition images gathered from the scope’s camera can be uploaded (in real-time) to a monitor located next to the surgeon.
Both methods have something in common. What they both have is a light source. As you may recall, there is simply no way to create an image without it. One might even say that it is the amount of light that determines exactly how big an incision must be.
Let’s walk through a simple analogy that explains how light can be used to alter our visualization.
Sally is standing just outside of her bedroom and wants to find something very small that’s located inside. From the doorway, Sally will need a flashlight to look inside the room. Of course, the more Sally opened the door (compare this to the incision size), the more light would pour in, and the easier it would be for her to find the keys. If she kept the door mostly closed (a tiny incision), the light would only illuminate a small area and would need to be very bright to see extra far. Sally might even consider using a magnifying glass.
Another solution Sally could try is using a long pole (compare to endoscope). She could attach the flashlight and a small camera to the end. Now, she can keep the door mostly closed and it doesn’t matter how bright her flashlight is because she can get as close to the object as she wants. Her camera has a zoom feature, so she can enlarge the image to whatever magnification is needed.
Endoscopes are revolutionary because they let surgeons get away with making smaller incisions, while still affording them crystal-clear visibility. Physicians in the sports injury field recognized this more than three decades ago. Back then, it made knee and shoulder conditions much easier to treat. Patients recovered quicker because there was less disruption to healthy tissues and their surgeons could actually see what they were doing. There’s no reason spinal surgery should be any different.