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ESS is a surgical procedure using micro-sized incisions (less than 1-inch) and small tubular systems in combination with an endoscope to visualize the surgical field. While endoscopic surgical approaches are commonly used to treat other areas of the body (eg, gastrointestinal), advances in optics, visualization of tissues, and spinal imaging make ESS a surgical treatment choice for many patients.
First, the patient is prepped for surgery including administration of a local anesthetic to block pain. A 1-inch or smaller skin incision is made and a tubular trocar (about the width of a pencil) is inserted. Depending on the patient’s specific diagnosis, the endoscopic technique may access the spine using one of two approaches: either an intralaminar (from the back of the spine between two laminae) or transforaminal (from the back/side of the spine into the neuroforamen; a nerve passageway) approach.
Next, a tiny camera is inserted through the trocar to the targeted area of the spine. Throughout ESS, the camera captures and projects real-time images of the operative site onto a monitor in the surgeon’s direct view. The endoscopic camera assists and guides the surgeon during the surgical procedure.
Potential Benefits: Small incisions and hyper-targeting of the surgical site means less trauma to skin, muscle, and soft tissues resulting in less blood loss and a faster recovery. Furthermore, most ESS procedures can be completed in about one hour allowing the patient to be back on their feet a few hours following post-operative recovery.
ESS is a highly specialized surgical skill that is somewhat still in its infancy. As such, relatively few spine surgeons perform ESS techniques with regularity to be proficient. Usually, endoscopic spine surgery is not suitable for revision surgery, cases of clear spinal instability, high-grade spondylolisthesis, and/or cancer.
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