Endoscopic techniques in spinal surgery.

Minimally invasive techniques are becoming more widespread in the surgical subspecialties. Standard open surgical procedures are being modified to become less invasive, with the hopes of decreased recovery time, lessened morbidity, and ultimately, cost savings. Improvements in technology have allowed the surgeon to peer into body cavities and create potential spaces such as the retroperitoneum and the neuroforaminal space without the need for traditional extensile surgical approach. Improved fiberoptics, light sources, and the advent of the 3-chip camera and the 3-dimensional camera have resulted in improvements in visualization of the structures surrounding the spine. Although the goals of endoscopic surgery are to maintain or improve visualization and minimize the approach related trauma, procedures must also prove efficacious and safe with at least equivalent results compared with their open surgical counterpart. Not all procedures may be applicable to minimally invasive approaches and just because a procedure can be done does not mean that it should be done. Laparoscopic and thoracoscopic spine procedures also depend on the partnership of the spine surgeon with the thoracic or general surgeon with endoscopic experience to ensure patient safety. Proficiency in minimally invasive spinal techniques takes devotion and does not occur after taking minicourses. Practice with cadaver and in vivo models, preceptorship and proctorship training, and ultimately the teaching of these techniques in residency and spinal fellowship programs will undoubtedly lead to favorable outcomes and reduced medical expenditure. Preliminary results are encouraging for endoscopic spinal surgery, but further testing of these new techniques against conventional open procedures will be important in documenting not only the efficacy of the procedure, but also its value in patient satisfaction and cost.