Who is a candidate?
Endoscopic fusion is considered for a narrow group: single-level instability such as a low-grade spondylolisthesis, or stenosis with movement at the level, where the anatomy allows complete disc preparation and implant placement through small portals. It is not suited to multi-level disease, significant deformity, or revision cases with extensive scar tissue.
How the procedure works
Two small portals are made: one for a high-definition endoscope under continuous saline irrigation, one for instruments. The nerve is decompressed under direct magnified vision, the disc is removed and the endplates prepared, and a spacer packed with graft material is placed into the disc space. Screws and rods are then placed percutaneously to stabilize the segment while the bone heals.
Recovery
Walking begins the same day, and hospital stay is usually short. The irrigated corridor means very little muscle disruption, so early incisional discomfort tends to be mild. Bending, lifting, and twisting are restricted while the fusion consolidates, and bone healing continues over several months regardless of how small the incisions were.
Benefits and alternatives
The intended benefits are a magnified view of the nerve during decompression and minimal muscle disruption, with the same stabilization as a conventional minimally invasive fusion. Alternatives include MIS TLIF, open fusion, decompression alone where the segment is stable, and continued non-operative care.
Risks
Risks include infection, bleeding, a tear in the lining around the nerves, nerve injury, hardware problems, and failure of the bone to fuse, which may require further surgery. As with any endoscopic approach, there is a possibility of converting to a larger exposure to complete the operation safely. Fluid used for irrigation requires careful management during the procedure.