Dr. Joseph Morreale is the founder and attending spine surgeon at MountainView Spine Center, a practice focused on providing highly skilled spine care for people who suffer from back pain. In this interview, we talk about one of his favorite surgical procedures—endoscopy.
What is endoscopy and how does it work?
Dr. Joseph Morreale: Endoscopy is a minimally-invasive spine surgery. It's a great way that we can decompress people. They're stab wound incisions, really speeding up their recovery, decreasing operative time, decreasing incisions. It's helped to get people back to doing what they want to do a little bit quicker.
Being minimally invasive, does that make it an outpatient surgery?
Dr. Joseph Morreale: Yes. In some cases, people can even be awake during the surgery, which is unusual for spine surgeries.
Walk us through the process of endoscopy surgery.
Dr. Joseph Morreale: [The patient] is in a prone position, face down, and then we use intraoperative X-ray. We start with a needle and then position a little cannula (a thin tube) in. Into that cannula we can pass various instruments to decompress the spine, if they have a herniated disc or stenosis, to take the pressure off those nerves, and do it all with a camera and small tools.
Now, what's the difference between this and a typical open procedure? If it's difficult to reach through an endoscope, we might have to do a typical open procedure. This makes it a little bit easier because we're able to do it through a stab wound, or two, which can be closed with just one stitch, as opposed to anything else. It's about minimizing what we're doing and going in and targeting where the disease process is.
You mentioned decompressions. Explain what that entails.
Dr. Joseph Morreale: Decompression is probably the easiest of all spine surgeries to go through. It means we're just removing something—maybe a tiny bit of bone, some disc, any other structures that might be compressing on the nerve. It's simple. Beyond that, we start talking about putting implants in, whether that's screws, rods, artificial discs, cages in the spine.
Which spine conditions are recommended for endoscopy?
Dr. Joseph Morreale: Most people have a herniated disc, which is commonly referred to as sciatica, which is pain down the leg, and that persists. Those tend to be the most common, but certainly, spinal stenosis can be [treated with endoscopy]. I'm not as much into this, so I use it mostly for people who need decompressions of herniated discs.
We try non-surgical measures first, such as medications, physical therapy, and injections. If those fail after a specific amount of time, then people become good candidates for surgery.
As far as patient prep, what should the patient do to prepare for endoscopy? Are there any requirements or precautions they should take?
Dr. Joseph Morreale: We ask patients to stay healthy as they can. A lot of times when people have spine conditions, it's hard to stay healthy. We typically send people to physical therapy first, and we work a lot on core strengthening in that physical therapy regimen. We're looking at six months, a year down the line so we want to try and keep that core strong.
What’s the success rates of the surgery?
Dr. Joseph Morreale: This is not one that we expect there to be multiple surgeries afterward. Well, like 98% success rate, depending on exactly why you [have a procedure]. A simple decompression has a fantastic rate. The literature's not quite out there on reherniation rates. People do re-herniate discs. Most often it occurs in the first six weeks because people sometimes get a little aggressive with what they're doing while their body's still healing. The overall success rate is amazing. People connect with it. With just a couple of stab wound incisions, people wake up and their leg pain is gone because we've taken that pressure off the nerve. People are getting better almost right away. They almost want to go out and do more than they should afterward.
What's the recovery plan for the surgery?
Dr. Joseph Morreale: Typically, the surgery is about an hour and a half between getting to the operating room and getting out of the operating room. The actual surgery is a little shorter. [Patients] typically go home the same day.
I let people walk as much as they want right away after surgery. They're feeling pretty good. We have what we call the BLTs: no bending, lifting, twisting for about six weeks. That's because those kinds of activities put increased pressure on the disc. They increase that chance of there being a new herniation. We restrict that a little bit. I try to slowly build them back into their activities after that six- to eight-week period, getting back to things like biking, golf, skiing, things like that; especially in Colorado, that's what people are interested in.
Can you describe the technology used in endoscopy?
Dr. Joseph Morreale: They're all very small tools, whether they're shavers, little things that can burn disc material, little pincers, that we can fit through a cannula. We're using a camera and looking at a screen, much like when you hear about people getting their knee scoped. You hear about that with athletes a lot. This is that same thing in the spine. It's just newer. It took us a little longer to develop this. I think we've been doing it for now for a few years, and every year, better equipment has been coming out as it's gained popularity.
What is the outlook for the endoscopy?
Dr. Joseph Morreale: We've noticed at the annual meetings over the past three, four years, it's gaining momentum. We're seeing more papers published on it. We're seeing more information about it. I'd say it's gaining momentum, but still, I don't think there are that many surgeons doing it. The way things work, I think some people are slow to adopt new technology and some people aren't. I would tell you that, especially, in the younger, active patient population, I think it's going to become a mainstay in the future.
Updated: June 9, 2021