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Scott Burnhope was riding his mountain bike one summer day in 2020 when he rounded a corner to find a rider coming from the opposite direction. He hit the brakes, wrenching his back as he lost control of his bike. He picked himself up, got back on the bike, and finished his mountain ride. But for the rest of that summer, while he continued riding, his back pain got worse.
After an MRI of his back in August, Scott learned that he had a slipped disc in addition to worsening spinal stenosis—a condition where the spinal column narrows with wear, tear, and age. For a few months, he went to a chiropractor, but four months after the accident, he could barely walk, managing only to stand for 10 to 15 minutes before the pain forced him to sit down.
"It was excruciating for somebody as active as me," the 57-year-old retiree says. He knew he could not continue living with such severely limiting pain and had to get the issue medically addressed.
He saw several doctors, one of whom said he would fix the herniated discs with a typical two-inch incision to gain access to the spine. Another doctor recommended he seek a less invasive surgical approach and see Mark Mahan, MD, a neurosurgeon at University of Utah Health who specializes in peripheral nerve and spinal surgery.
Mahan told him that the same spine surgery could be performed with a much smaller incision. Moreover, he could resolve Scott's spinal issues during an outpatient procedure. "I'd be in and out the same day and the healing process would be much quicker," Scott recalls Mahan telling him. What also made Scott more comfortable about the prospect of the procedure was that Mahan had been performing minimally invasive spinal surgeries for four years. He also taught the procedure throughout the country.
Endoscopic spinal surgery is not only for physically fit people struggling with severe pain issues relating to spinal compression like Scott's. Mahan argues that such an approach "expands opportunities for certain patients, those that are older or a little bit frailer and for whom a small surgery and quicker recovery makes sense, particularly when doing an open procedure has greater risks."
Mahan's long-term focus as a neurosurgeon was trying to minimize surgical consequences for patients. "Every surgery is trauma to tissue," he says. At a 2016 National Institutes of Health conference, he was intrigued to learn that endoscopy—inserting a long, thin tube into the body to examine an area of concern in detail—was being used in Europe and Asia for spinal surgeries.
Endoscopic spinal surgery is limited in scope to primarily disc herniations and the narrowing of the spinal cord. "Essentially, it's the same as an open procedure but done with smaller tools, so it takes longer," Mahan says. "It's like painting with a watercolor brush instead of a wide paintbrush."
Mahan highlights the precision and the surgical economy that the procedures can offer. Endoscopic optics provide angled vision. "It allows you to see around corners and do things without having typical linear visualization," he says. "With an endoscope, you don't need to remove things to see, and you can achieve a decompression of the spine that removes less bone."
Scott was required to get a COVID test, then went in for surgery in February. He was on the operating table by 10 am for a surgery that took close to an hour. Mahan made a seven-millimeter skin incision through which to work the fiber optics and a miniaturized, lengthened version of a surgical drill. "Using a pump with saline irrigation, we can push away the nerve roots and other elements to create a working space," Mahan says. He removed some of the bones and ligament, opening up the spinal cord so the nerves were no longer squeezed. Relieving the compression allows more blood flow and the nerves to heal. Being able to have space to work while not exposing the spine to air "minimizes any bleeding," Mahan says. "And there's a phenomenally low risk for wound infection."
By 4:30 pm, Scott was on his way home. "I was sore the day after," he recalls. "But the numbness and pain I had before had completely gone."
In contrast to a spinal surgery that involves a larger incision, where providers must spend a lot of time coaching someone through their recovery period, "we have to hold the patient back a little" after endoscopic spinal surgery, Mahan says. Patients call in the day after the surgery to ask if they can take their snowmobile out that day. Mahan and his team have to tamp down that enthusiasm for immediately returning to an active lifestyle, urging patients to allow for some time for recovery.
Scott got all his movement back and was quickly able to return to walking three or four hours a day. "Everything in my life is getting back to where it used to be," he says. "I'm a different person because of this."