What is spinal endoscopy?

During spinal endoscopy, the patient is positioned according to the area being treated (lumbar, cervical or thoracic). A very small incision, typically 5 to 8 millimetres, is then made without damaging muscles or ligaments.

The surgery is usually performed under total intravenous anaesthesia (TIVA), which ensures optimal pain management control and patient comfort. In selected cases — such as shorter procedures or patients with special conditions — conscious sedation and local anaesthesia may be used instead.

Using real-time imaging (radiology or neuronavigation), the neurosurgical specialist inserts the endoscope — a very thin high-definition camera — to provide visualisation of the inside of the spine and for highly precise work directly on the affected area. Once inside, the following operations can be performed:

• Resection/removal of herniated intervertebral disc fragments that compress the nerves
• Nerve root decompression
• Insertion of implants (interbody cages) between vertebrae when vertebral instability or advanced disc degeneration is present
• Collection of tissue samples for analysis

It usually takes between 45 and 90 minutes. Once the procedure is complete, the incision is closed with a single stitch or an adhesive strip. In most cases, the patient can walk within a few hours and be discharged either the same or the following day.

It is used both to treat and diagnose spinal disorders. Some of its main indications include the treatment of:

• Disc herniations (lumbar, cervical or thoracic)
• Narrowing of the spinal canal (spinal stenosis)
• Chronic or degenerative low back pain (e.g. facet syndrome and discogenic pain)
• Reoperations in previously operated patients
• Stabilisation of the spine with implants (interbody cages), in cases of instability or disc deterioration

It can also be used as a diagnostic tool to:

• Directly visualise the spinal canal when imaging tests are inconclusive
• Obtain biopsies or tissue samples for analysis

Although it is a very safe technique, some uncommon complications may occur:

• Mild pain or swelling in the area
• Infection of the intervertebral disc caused by bacteria, fungi or viruses (discitis) This is very rare, however, due to preventive antibiotics
• Cerebrospinal fluid leakage
• Temporary nerve injury
• Recurrence of the disc herniation

There are certain recommendations you should follow before the procedure:

Spinal endoscopy is not suitable for every case and must be carefully assessed in patients with:

• Active infections
• Severe coagulation disorders
• Complex vertebral malformations
• Extensive fibrosis from previous surgeries
• Allergies to anaesthetics or surgical materials

The neurosurgical specialist will evaluate the safety and feasibility of the procedure on an individual basis.

During surgery, the patient will feel no pain due to total intravenous anaesthesia. After the procedure, it is common to experience slight discomfort in the treated area or lumbar stiffness; this can be managed with mild painkillers.

In most cases, the patient can stand up and walk the same day and resume normal activities within a week or two; although strenuous physical exertion must be avoided for the first month.

At the Hospital Clínic, spinal endoscopy is performed by a neurosurgeon specialising in minimally invasive spine surgery, with extensive experience in endoscopic and advanced navigation techniques.

The procedure also requires:

• An anaesthesiologist specialising in total intravenous anaesthesia (TIVA) and advanced sedation.
• A highly specialised surgical nursing team.

The success of the technique depends largely on the surgeon’s accuracy and coordination with the surgical team.