Scott Burnhope was riding his mountain bike on a summer day in 2020 when he turned a corner and saw a rider coming in the opposite direction. He hit the brakes and twisted his back as he lost control of his bike. He got to his feet, got back on his bike, and finished his ascent. But for the rest of the summer, as he rode on, his back pain got worse.
After an MRI of his back in August, Scott learned that in addition to worsening spinal stenosis, he had a herniated disc – a condition in which the spine narrows with wear and tear and age. He went to a chiropractor for a few months, but four months after the accident he was barely able to walk and only managed to stand for 10 to 15 minutes before the pain forced him to sit down.
“For someone as active as me, it was horrific,” says the 57-year-old pensioner. He knew that he could not go on living with such severely debilitating pain and had to solve the problem medically.
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He saw several doctors, one of whom said he would repair the herniated disc with a typical two-inch incision to gain access to the spine. Another doctor recommended that he take a less invasive surgical approach and see Mark Mahan, MD, a neurosurgeon at the University of Utah Health who specializes in peripheral nerve and spine surgery.
Mahan told him the same spinal surgery could be done with a much smaller incision. In addition, he was able to solve Scott’s spine problems during an outpatient procedure. “I would go in and out on the same day and the healing process would be much faster,” Scott recalls, Mahan telling him. What also made Scott more comfortable with the prospect of the procedure was that Mahan had been performing minimally invasive spinal surgery for four years. He also taught the procedure across the country.
Endoscopic spine surgery isn’t just for physically fit people who are struggling with severe spinal compression-related pain like Scott’s. Mahan argues that such an approach “expands the chances of certain patients who are older or slightly more frail and for whom minor surgery and faster recovery make sense, especially when an open procedure is more risky”.
Mahan’s long-term focus as a neurosurgeon has been to minimize the surgical consequences for patients. “Every operation is a tissue trauma,” he says. At a National Institutes of Health conference in 2016, he was intrigued to learn that endoscopy – the process of inserting a long, thin tube into the body to examine an area of concern in detail – is being used in Europe and Asia for Spinal surgery is used.
Endoscopic spine surgery is mainly limited to herniated discs and the narrowing of the spinal cord. “It’s essentially the same as an open process, but it’s done with smaller tools so it takes longer,” Mahan says. “It’s like painting with a watercolor brush instead of a broad brush.”
Mahan highlights the precision and surgical economics that the procedures can provide. Endoscopic optics make it possible to see at an angle. “It allows you to look around corners and do things without having a typical linear visualization,” he says. “With an endoscope, you don’t have to remove anything to see, and you can decompress the spine with less bone removed.”
Scott had to undergo a COVID test and then had an operation in February. He was on the operating table at 10 a.m. for an operation that lasted almost an hour. Mahan made a seven millimeter skin incision through which the fiber optics and a miniaturized, elongated version of a surgical drill were machined. “With a saline pump, we can push away the nerve roots and other elements to create a workspace,” says Mahan. He removed some of the bones and ligaments and opened the spinal cord so that the nerves would not be squeezed again. Relieving the compression allows more blood to flow and the nerves to heal. Having space to work without exposing the spine to air “minimizes any bleeding,” says Mahan. “And the risk of wound infection is phenomenally low.”
At 4:30 p.m. Scott was on his way home. “The day after, I was in pain,” he recalls. “But the numbness and pain that I had before were completely gone.”
In contrast to spinal surgery with a larger incision, where providers have to spend a lot of time coaching someone during the recovery phase, “we have to hold the patient back a little after endoscopic spinal surgery,” says Mahan. Patients call the day after surgery to ask if they can take their snowmobile with them that day. Mahan and his team need to dampen this enthusiasm for an immediate return to an active lifestyle and urge patients to allow themselves some time to recover.
Scott got all his movement back and was able to quickly walk three or four hours a day again. “Everything in my life is back where it was,” he says. “That’s why I’m a different person.”