Rare minimally invasive approach now available at Johns Hopkins

Surgeons in the Johns Hopkins Department of Orthopaedic Surgery’s spine division are now providing minimally invasive endoscopic surgery, which is used frequently in other specialties but is uncommon in spine surgery. Sang Lee, assistant professor of orthopaedic surgery and director of complex cervical spine and spine tumor surgery, is leading implementation of this approach, which the department began to offer over the last several months.

“Endoscopic spine surgery has been historically more common in Asia and is recently gaining popularity in the United States. However, it is mainly performed by private surgeons, not academic practices,” Lee says. He hopes to popularize endoscopic spine surgery among academic practices in the U.S. because of its many benefits. “It is the least invasive surgery and uses an incision of less than 1 centimeter,” Lee says. “Outcomes are similar to traditional open surgeries, but there are quicker recovery rates, shorter hospitalization times, and it is the better option cosmetically.” Endoscopic surgery is used to treat less complicated spine conditions such as disc herniation and spinal stenosis, and can be performed in an outpatient setting. 

Incorporating this technique will also provide valuable learning opportunities for surgeons in the spine division’s residency program. “There is a steep learning curve of at least 20 initial cases. It requires a steadier hand,” says Lee. Surgeons training in endoscopic surgery participate in cadaver training courses to refine their techniques. Initially, the endoscopic approach may take one to two hours longer than more invasive procedures. However, the skills required are similar to those needed for open surgery. “I explain to students that you need to be able to see every anatomical characteristic in your mind’s eye,” Lee explains. “When you see a patient in the clinic, you should be able to picture the spinal cord, nerve roots, vessels, and all the critical structures.”

Lee is excited by the opportunities available in the spine division, which he says “have expanded greatly in the past two years.” He is eager to help Johns Hopkins become a leader in endoscopic spine surgery among academic institutions, and to provide an option with less tissue damage, less blood loss, and shorter hospitalization and recovery.

Published in Framework Fall 2019 and OrthopaedicSurgery Winter 2020.