The World Wide State of Endoscopic Spine Surgery- Saqib Hasan, M.D.

Summary

The script discusses the evolution and global impact of endoscopic spine surgery, highlighting its transition from a niche procedure to a widespread platform. It emphasizes the importance of embracing change in medical technology, the pathway to widespread adoption, and the influence of various regions in shaping the field. The speaker underscores the significance of surgeon and patient demand, training, and the challenges of old-guard resistance. The narrative also touches on the historical development, current status, and future trends of endoscopic spine surgery worldwide.

Takeaways

• 🌐 Endoscopic spine surgery is a global movement and a platform that has leveraged technology to improve patient care standards worldwide.
• 💡 The concept of embracing change in medical procedures is likened to the strength of bamboo, symbolizing flexibility and resilience in the face of innovation.
• 💡 The adoption of new surgical ideas typically follows a pathway that includes proof of concept, industry partnerships, regulatory approval, and most importantly, surgeon and patient demand.
• 📚 Historically, the idea of using an endoscope for spinal cord visualization dates back to the 1930s, with significant developments in the 1970s in Philadelphia and Tokyo.
• 🌟 The introduction of endoscopic spine surgery in Europe by Adam Schreiber and Hanor Glow, and its advancement in Japan by Suzawa, marked the beginning of a new field in minimally invasive surgery.
• 📈 The spread of endoscopic spine surgery has been characterized by the development of new techniques, such as the biportal approach, and the use of technological advancements like Indigo Carmine for staining degenerative discs.
• 📊 The growth of endoscopic spine surgery has been influenced by various factors including cultural reasons, politics, economics, and the ease of understanding and training accessibility.
• 🌍 Geographical analysis shows varying levels of adoption and demand for endoscopic spine surgery, with regions like South Korea, Brazil, and China showing significant contributions and advancements.
• 🔑 Key to the future of endoscopic spine surgery is the development of better tools, techniques for dural and nerve root repair, and the integration of technologies like navigation, robotics, augmented reality, and AI.
• 📈 The current adoption rate of endoscopic spine surgery in the US is relatively low, with an estimated 1-5% of spine surgeons incorporating these techniques, indicating a potential area for growth and education.
• 🔑 The future trends in endoscopic spine surgery will likely focus on improving patient outcomes, reducing costs, and enhancing the learning curve for surgeons through better training and technological integration.

Q & A

What is endoscopic spine surgery and why is it significant?

Endoscopic spine surgery is a minimally invasive surgical approach that leverages technology to elevate the standard of care for patients. It's significant because it offers smaller incisions, faster recovery times, and often leads to higher patient demand due to its less invasive nature compared to traditional spine surgery.

Why does the adoption of endoscopic spine surgery vary across different regions?

Adoption varies due to factors like cultural reasons, politics, economic factors, surgeon demand, patient demand, and access to training. Some regions may have more resistance to change or face barriers in national and social health systems that dictate care.

What role did NYU Hospital for Joint Diseases play in the history of endoscopic spine surgery?

NYU Hospital for Joint Diseases in New York City is mentioned as the hometown and training place of the speaker, where early ideas of using an endoscope to visualize the spinal cord were conceptualized back in the 1930s.

Who were some of the pioneers in the development of endoscopic spine surgery techniques?

Pioneers include Dr. Camp and Dr. Hijikata who inserted a cannula for percutaneous disc removal in the 1970s, Adam Schreiber and Hanor Glow who introduced the endoscope for discectomy at the BGR Hospital in Switzerland, and Dr. Tony Young who developed the first commercially successful uniportal working channel endoscope.

How has South Korea contributed to the advancement of endoscopic spine surgery?

South Korea has significantly contributed by developing specialized centers like the Wordle Hospital, advancing indications and techniques, and becoming a hub for technical innovation and research in endoscopic spine surgery.

What is the 'half and half technique' mentioned in the script?

The 'half and half technique' is a targeted endoscopic technique developed in South Korea that combines European and American concepts of inside-out and outside-in approaches to endoscopic spine surgery.

What are the current challenges and future trends in endoscopic spine surgery?

Challenges include better tool development, improved dural tear repair options, and determining the role of endoscopic fusion. Future trends involve leveraging technologies like navigation, robotics, augmented reality, and AI to further advance the field.

Why is there a debate between uniportal and biportal techniques in endoscopic spine surgery?

The debate arises because uniportal offers more versatility and can be used for a wider range of procedures, while biportal has a faster learning curve and is often more cost-effective. The choice between the two depends on the surgeon's expertise, patient needs, and the specific surgical case.

What impact does the US have on the global trends of endoscopic spine surgery?

The US, with its private healthcare system and focus on innovation and technology, plays a significant role in setting global trends. However, the focus on spinal fusion and coding issues has somewhat slowed the adoption of endoscopic spine surgery techniques in the country.

How has the academic community contributed to the growth of endoscopic spine surgery?

The academic community has contributed by developing specialized fellowships, conducting high-quality research, and establishing research groups and foundations that advocate for and educate future generations of spine surgeons.