“Oh, my aching back!” It’s a phrase we’ve all heard – or perhaps even groaned ourselves. For many, it’s more than just a fleeting complaint – it’s a constant companion that can turn daily life into a battle.
“Back pain is something that pretty much everybody will experience at some point in their life and the vast majority of people will get over it without any real intervention,” said Dr. Matthew Morris, the newest orthopedic surgeon to join the team at Vero Orthopeadics. “We do things like physical therapy and medications and maybe even some injections to help their recovery speed along the way, but most people get over it without the need for surgery.
Spine surgery is the last option. I exhaust all conservative measures before I resort to surgery. It really depends on when I start seeing somebody in terms of the progress of their care.”
Fortunately, advances in spinal surgery are offering better outcomes to those with chronic back pain who do need surgery. Advancements in the field have significantly reduced recovery times and surgical risks.
Minimally invasive spine surgery (MISS) has become increasingly popular in recent years, offering patients less traumatic alternatives to traditional open surgery. Within the spectrum of minimally invasive techniques, endoscopic surgery stands out due to a range of benefits, making it a preferred choice for both surgeons and patients in applicable cases.
“For those who aren’t getting better, and their quality of life is really suffering, we explore surgical options,” Dr. Morris said. “In some cases, endoscopic surgery makes sense from a minimally invasive perspective in terms of limiting the amount of post-operative pain that they are going to have, limiting the risk of complications and making sure they are not under anesthesia for too long.”
One of the primary advantages of endoscopic spine surgery is its superior visualization and precision. Using a high-definition camera attached to an endoscope, the surgeon can directly visualize the surgical site on a monitor which allows for detailed and accurate manipulation of tissues. Enhanced visualization is especially beneficial in complex spinal surgeries where precision is crucial to avoid damage to surrounding nerves, blood vessels and other vital structures.
“With most traditional spine surgeries, we make a midline incision in the back, and you have to peel the muscles off in order to be able to visualize the bone and remove any diseased bone and ligament that might be compressing neurologic structures or weak discs,” Dr. Morris explained. “Endoscopic is a way of making a very small incision in the back using an endoscope similar to an arthroscope for a knee or shoulder arthroscopy. We use similar equipment in the spine and visualize the bone on camera and use minimally invasive tools to remove any bone and ligament. I can split the muscle instead of peeling it off the bone and that allows me to reach the spine and take care of the problem fairly easily and quickly.”
Because endoscopic surgery incisions are often less than 1 centimeter in size, they lead to less muscle and soft tissue damage around the spine, resulting in reduced postoperative pain and lower risk of infection. Patients who undergo endoscopic spine surgery often experience a shorter recovery time and less postoperative discomfort.
“Typically, we do endoscopic surgery in a surgery center and have the patient up and walking the very same day and even leaving the same day,” Dr. Morris continued. “Because there is less postoperative pain, we don’t prescribe any opioid medications so there won’t be and kind of side effects that come with that.”
The time it takes to do the procedure is a deciding factor in determining which type of minimally invasive surgery to employ.
“I still use a tubular retractor for a good amount of pathologies,” Dr. Morris said. “I have to think about how long the procedure is going take and how long the patient will be under anesthesia and is it worth the risk just make a very small incision. In many cases a minimally invasive muscle splitting approach with a tubular retractor can get it done quicker, but the incisions are larger. The recovery time is similar. It takes a little longer to tackle some problems endoscopically and you have to balance that risk of being under anesthesia for too long verses doing another minimally invasive approach where I use a tubular retractor.”
Endoscopic spine surgery addresses a wide range of spinal conditions from herniated discs and spinal stenosis to degenerative disc disease and certain types of spinal tumors. Its adaptability makes it suitable for both cervical and lumbar spine surgeries, and its ability to access hard-to-reach areas and perform complex procedures with minimal disruption gives it an edge in treating a broad spectrum of spinal issues.
Dr. Morris emphasized that endoscopic surgery has been around since the early 2000s, but it is gaining more traction now because of the mitigation of pain associated with this type of surgery and quicker recovery. Successful outcomes after endoscopic surgery are equal to traditional open surgery.
“Spine surgery sometimes feels more like art than science,” Dr. Morris concluded. “If you take a complex problem and bring it to 10 different spine surgeons, you might get 10 different answers. Certainly, there’s a right way and a wrong way but, there is so much info in between that it allows each of us to take an individualized approach for each patient and determine the best option.
“Sometimes when we see a patient’s MRI, we know exactly what to do. Other times the patient may clearly have a deformity or scoliosis, but they are basically doing OK with just a little leg pain and if we just shave a little bone off or remove a ligament they’ll be back doing the things they want to do. It would be doing them a huge disservice by going in with a sledgehammer so to speak and tackling everything.”
Dr. Matthew Morris is a fellowship-trained orthopedic and neurological spine specialist offering advanced care for back, neck and spine pain and dysfunction. He received his medical degree at Albert Einstein College of Medicine in the Bronx, New York, and served his orthopaedic surgery residency training at Northwell Health at Long Island Jewish Medical Center/Hofstra University in New Hyde Park, New York. He went on to complete an orthopaedic and neurosurgical spine fellowship at Duke University Health System in Durham, North Carolina. He can be reached at Vero Orthopaedics in Vero Beach: 772-758-1017.
