Active Again—Endoscopic Spine Surgery Changes the Game

Back in 2004, anyone that walked into Randy Oldham's would be met with an unexpected sight: a bed in the middle of his kitchen. While many found it strange, to Randy and anyone who knew him, it was an absolute necessity.

After having back surgery to fuse two vertebrae in his damaged spine, Randy could hardly move himself. He was in his 40s and very athletic, snowmobiling, swimming, running, golfing, and biking. Always pushing himself physically took its toll—but so did the fix.

Major surgery hospitalized him for two nights. Then, physical therapy and recovering at home took months. Randy said it took him a year and a half to fully come back. When he learned he once again faced back surgery this year following the return of severe pain in his spine, he was devastated and dreading a similar outcome.

 “My past experience was horrible and mentally really tough to accept, losing so much of life during recovery,” he said.

But this time, Randy turned to University of Utah Health and Mark Mahan, MD, for endoscopic spine surgery—a minimally invasive procedure that can help correct spine issues and relieve back pain.

Mahan specializes in complex peripheral nerve surgery, spine surgery, and neurologic reconstruction. In fact, he’s the only neurosurgeon in the Mountain West who performs complex nerve surgery. For Randy, the focus was on his spine, just above the old lumbar fusion.

“Randy’s case was a bit more complicated than average, in part because of working in an area previously operated on,” Mahan explained.

Randy also had a lot of wear and tear, which Mahan notes can happen near an area of the spine that’s been made rigid. Mahan thought it could be mostly repaired through an incision about the width of a fingernail. The surgeon uses tools that fit inside a scope just eight millimeters in diameter. The tiny camera traveling inside the body provides both light and angled vision.

“You have a 15- to 30-degree view, so you can work around corners,” Mahan said. “In some respects, it’s almost like building a ship in a bottle.”

From digital images, Mahan precisely pinpointed the problem area and corrected the narrowing spinal canal without moving muscles from the spine, as traditional back surgery requires. This focused approach is possible when a patient is dealing with degeneration in just one or two levels, or vertebrae, in the spine.

“With the endoscope, while viewing on a monitor, I was able to target the problem space, removing the bumps and lumps compressing Randy’s nerves,” Mahan said.

Such age-related degeneration and arthritic boney growth are common, and removing it endoscopically has many benefits compared to open surgery, including less tissue trauma, joint disruption, and bleeding, all of which can lead to a faster recovery.

To Randy, the procedure was “pretty slick”—and an all-around completely different experience from his last back surgery. Randy was pleasantly surprised with his near-immediate pain relief, and when asked about the day of the procedure, you could hardly tell he even had surgery.

“We talked to Dr. Mahan, I went into surgery, got out of surgery, was on the road for an hour and a half, got home, took a nap, then went on the treadmill and walked half a mile, with really no pain at all,” he said.

The 62-year-old walked about three miles the very next day. Overall, he says he’s experienced a 75 percent reduction in pain. Being active after traditional back surgery, however, is not usually possible, even for athletic patients like Randy, who says the recovery difference is like night and day.

Mahan is glad to say that a quick recovery following endoscopic spine surgery is common, especially if you keep the body moving, albeit carefully.

“I want people up and moving because you're less likely to get clots in your legs or have muscle spasms,” Mahan said. “You don't have that dip in health associated with surgery if you're active immediately afterwards.”

Endoscopic spine surgery became widely available about ten years ago, with improved technology increasing its use over the last five years. Mahan says it’s great for simple structural spine issues such as spinal stenosis or a herniated disk and for people who are more likely to have complications from more invasive procedures.

Spinal fusion surgery, on the other hand, is often best in cases of spinal instability and to realign slipped disks, but it has a much higher complication and infection rate. That’s why Mahan, who teaches endoscopic surgery nationally and internationally, is researching endoscopic fusion techniques.

“With endoscopic surgery, the circulating air never hits the tissue bed,” Mahan said. “It's a closed system, so bacteria cannot cross over to cause infections,”

Endoscopic spinal fusion is a fast-evolving area of expertise, with a multitude of approaches depending on the level of the spine addressed and the condition being treated. Mahan plans to keep pushing the envelope.

“I love that you’re able to say, ‘Go home and live life’ after endoscopic procedures,” he said.

These days, Randy’s back to mountain biking a few days a week. “This experience really opened my eyes,” he said. “Now I tell everyone it gave me my life back—and it did so a lot faster than I thought it would.”