An ‘adventurous’ approach to endoscopic spine

Endoscopic spine’s growth will depend on a forward-thinking mindset among surgeons and pushing new boundaries, Xiaofei (Sophie) Zhou, MD, said.

Dr. Zhou, associate program director of the neurosurgical residency at Cleveland-based University Hospitals, discussed what’s ahead for an upcoming episode of the “Becker’s Spine and Orthopedic Podcast.” 

Note: This is an edited excerpt.

Question: Technologies like endoscopic spine surgery have been crucial in moving more patients to the outpatient setting. How do you envision the role of inpatient spine care evolving? How is University Hospitals’ spine program adapting?

Dr. Xiaofei Zhou: There’s always a push towards getting patients out and at home sooner. I think patients almost always heal better when they’re in their own environment. But we definitely have to counterbalance that with patient safety. You don’t want to send somebody home who may not be able to handle it, especially in a patient population that tends to veer older and who may have mobility issues. For these ultra minimally invasive surgeries, patients tend to bounce back a lot faster because they’re smaller procedures, and those are the first ones that we should think about putting into an ASC. But there should also be guardrails. You should also understand that just because someone has an endoscopic surgery, or just because someone has a minimally invasive surgery, it might be beneficial for the patient to stay a day just for observation. Like anything else, we have a good framework of what to do for each patient, but at the end of the day, it has to be individualized.

Q: How will endoscopic spine evolve in the next two to three years? What will the next generation of this technology look like?

XZ: I think that it’s going to expand in terms of its abilities. The technology is limited right now by the kinds of tools that are at your disposal, and as we get more adept at entering the spine and this totally new view, we might be able to handle things that are a lot more complex. We might be able to handle things that include fusions. We have endoscopic transforaminal lumbar interbody fusions, but I think there are other avenues that we can explore. But I think it also begs the question of how many people actually need fusions if we can do a minimally disruptive surgery? There’s obviously a role for scoliosis surgery, large deformity corrections, and that’s certainly not something I think endoscopic spine is going to venture into in the next two, three years. But as we get more adept at seeing what the outcomes are pushing boundaries, we might be able to see new ways of utilizing endoscopic spine. 

One of the things that I’ve done recently is a removal of an epidural abscess for a diabetic patient who had poorly controlled diabetes, was overweight and had all the hallmarks of being a poor surgical candidate. But you don’t want to have someone who’s already infected with an epidural abscess with a huge surgical scar that may never heal. By utilizing the endoscope, I was able to take out the entire epidural abscess through an incision the size of my fingernail, and this patient healed beautifully. She was able to take her antibiotics, her pain was gone, her nerves were decompressed and she started regaining some of the function that she had lost due to the compression of this abscess. 

I think as we get more adventurous and as we see new avenues for use, it’s going to be a very organic growth for endoscopic spine. With more and more residencies and fellowships adopting endoscopic spine, people are going to learn it as part of their general surgical training, and they’re going to be the ones who push the envelope. 

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