Jaime Lewis (Host): Back and neck pain affect millions of Americans. And for some, surgery becomes necessary when other treatments can't provide relief. Fortunately, advances in surgical techniques now offer patients less invasive options with faster recovery times. Here to discuss ultra-minimally invasive endoscopic spine surgery is Dr. Sophie Zhou, a neurosurgeon at University Hospitals, a partner of Southwest General Health Center. She'll explain how this innovative approach is helping patients get back to their lives with less pain and downtime.

This is Southwest General Health Talk, the podcast from the specialists at Southwest General Health Center. I'm Jamie Lewis. And Dr. Zhou, thank you for being here.

Xiaofei (Sophie) Zhou, MD: Thank you for having me.

Host: So, many of our listeners may be dealing with back or neck pain. Could you explain what endoscopic spine surgery is and what types of conditions it can help with?

Xiaofei (Sophie) Zhou, MD: Endoscopic spine surgery has been around for a while, but it's become recently more popular because it's been more widely adopted. But what is very cool about it is that right now what we're using it for is to treat herniated discs, mostly in the lumbar spine. As you said, a lot of patients in the U.S. and around the world have back pain, but most people don't know that up to 2% of the population can have a herniated disc, which is crazy, right? That means pretty much everyone you know knows someone who's had a herniated disc surgery or has had a herniated disc themselves.

Traditionally, we do large surgeries, open surgery, so we can directly visualize the disc with a microscope. And then, in order to get the disc, we have to shave off some amount of bone and remove the disc from there. But what is really innovative about this ultra-minimally invasive surgery is that we put the camera directly into the spine. The camera kind of looks like a pencil. And so, when we insert it into the spine, the only incision we have to make is about the size of my thumbnail. So, the incision is super small. The recovery therefore is super limited. And most patients are on their feet again within the first two weeks after surgery. And by on their feet, I don't mean just walking around. I mean back to their normal activities. I actually want them to up and walking the same day. So, people go home the same day, they're back to work, back to their lives.

And the other thing to note about these kinds of patients is that most of the patients that we see doing these kinds of surgeries or having these kinds of issues are young men. They're usually like in their 30s. So, getting our workforce back and back to not just work, but to their lives and to doing the things that they love is huge, right? Because you don't want people laid up and in their houses and bedridden. You want people to be back and active.

Host: That's a really good point. And actually, since you mentioned it, I have a friend who had this surgery and was up and walking the same day and we were like, "Calm down," you know, "Take care of yourself." And he said, "No. Doctor's orders, actually."

Xiaofei (Sophie) Zhou, MD: Yeah. Because you don't want to be laying around. That's how you get blood clots. So if I can get you to move, I'm going to get you to move.

Host: Amazing. Well, for somebody who's maybe considering this kind of surgery, what are the main benefits of choosing ultra-minimally invasive approaches compared to traditional surgery?

Xiaofei (Sophie) Zhou, MD: So right now, it's pretty limited in where it's offered. I mean, it's bigger, it's more widely adopted, but still relatively limited. But if I were a patient and I was eligible for a ultra-minimally invasive surgery, that's what I would do, because the incision is so much smaller. That means there's a whole lot less trauma. And what I tell people is, "Hey, you know, sometimes I may not be able to get this disc through this ultra-minimally invasive procedure. But by doing this procedure, I haven't burned any bridges," meaning if it doesn't work, I can always go bigger. I can always open up and go after the disc in that same procedure or even later. But I haven't burned any bridges because I haven't taken down any bone. I haven't removed any ligament. I haven't done anything to you, right? So, it kind of is the best of both worlds. If it works for you, which for the majority of my patients it does, then it's great. You're feeling pain, you're feeling so much better. But if it doesn't work, we've also salvaged-- we have a salvage therapy, right? We have other things that we can still do, which I think is great.

Host: That is cool. Well, I understand that Southwest General was the first hospital in Northeast Ohio to offer this kind of technology. What should patients know about the procedure itself? How long does it take? What can you expect on surgery day?

Xiaofei (Sophie) Zhou, MD: So when you come in on surgery day, I'm going to come check you in, make sure that your leg pain still matches with what I saw in the MRI from when I met you in clinic. And then, the anesthesiologist and their team are going to meet you. We'll bring you back to the OR. You'll go to sleep. And then, we're going to use a series of x-rays to find the location to insert our camera.

It takes about an hour and a half to two hours for us to take out the disc, because we're taking out the disc in small pieces usually through a camera. And then, we'll close. The closure is the easiest part of the surgery, since I'm really only closing this tiny little incision. And then, you get to go home as soon as you're awake from anesthesia. And then, you'll see me in the office a few weeks later just to make sure everything is okay .But I'm always available by phone or otherwise if the patient needs me sooner.

Host: We talked already quite a bit about recovery, but is there anything else you want to add about what somebody could expect in terms of recovery, both on the day and following up?

Xiaofei (Sophie) Zhou, MD: I think the main thing to take away from this is even traditional microdiscectomies or this kind of surgery to remove herniated discs, most people recover well from, right? Because at the end of the day, this incision is really not that big. But the real advantage of the ultra-minimally invasive surgery is the smaller the incision, the less bleeding, the less infection risk, and patients get to go home and they're more likely, studies show, go back to work.

So right now, if I were to do a traditional surgery, I'll tell patients, probably wait six weeks before you go back to work because of all the muscle dissection. And with these ultra-minimally invasive surgeries, patients tend to go back to work within two weeks. So, I think that that's what they can expect. They can expect to be sooner, faster.

Host: Well, what questions do you encourage patients to ask when they're considering this kind of surgery? How do you help them decide if it's the right approach for them?

Xiaofei (Sophie) Zhou, MD: The questions I always ask my patients, and the questions I think they should ask any surgeon that they meet is, "Have I done everything that I can?" Because surgery should not be the first tool out of the toolbox, right? We should try everything we can do to avoid surgery in the first place. So, I always tell my patients, "Did you go to physical therapy? Did you try injections? Did you try steroids? Did you try pain medications?" And if all of those things have failed, then I'm always going to be here. I'm going to be here to do your surgery should you need it. But I think those are the questions my patients should ask me. Like, did you exhaust all of the tools in your toolbox before we head to surgery?

And then, they should ask all the questions you've already asked, right? "How long is my recovery? What can I do to take care of my wound? Should I shower?" Yes, you should absolutely shower after your surgery. But those are all the questions that my patients would ask.

And I think if I were a patient and I was undergoing a surgery myself, I would also ask what are my limitations, right? Because herniated discs, the funny thing about herniated discs is they can happen again. Just because we remove the herniated portion of the disc, it does not does not mean that we fixed the root cause, which is that your disc is malfunctioned. Your disc is no longer intact. So, up to 15% of patients can have a reherniation of that disc. So, I would ask that question. I would say, "What are my options should this happen again?"

And that's also the cool thing about endoscopic spine surgery, right? Because in such a small surgery, it leaves very little scar, which means I can go back again and go after that same disc again. And I don't have to worry as much about scar tissue. Now, obviously if you start herniating your discs the third or fourth time, then it's probably time to talk about another surgical option, and just removing the disc may not be enough.

Host: Well, I'm thinking about people who, you know, there's always that person out there I think about who's maybe listening to this, watching this, and they've been suffering with back pain for so long, it feels. It's a chronic problem and it feels like it's been forever. What message of hope would you want to share with them about the possibilities of this technology?

Xiaofei (Sophie) Zhou, MD: Yeah. I think that everybody probably goes through a little bit of back pain, and it's really hard when you're the one suffering through it, right? I don't think anyone can experience the pain that you have in your body and no one understands, even if you tell me. I can't understand because I'm not you.

But I do think that there's hope out there, right? Just because I may not be able to fix it with this technology, it doesn't mean there aren't other technologies out there. I think the cool thing about Southwest, about UH is that we have this great embrace of technology. So even if this one specific tech isn't for you, it doesn't mean there isn't other options out there. And I think to see that this hospital embraces technology in such a unique way means that we'll always be on the lookout for what's next and what else we can do to help you. So, I wouldn't feel too down in the dumps and feel like you're stuck. I feel like we're going to work with you to try to find a solution.

Host: Yeah. It really seems that way. Thank you, Dr. Zhou, so much for the work that you do and for sharing with me today.

Xiaofei (Sophie) Zhou, MD: Of course. 

Host: That was Dr. Sophie Zhou, neurosurgeon at University Hospitals, a partner of Southwest General Health Center. To schedule an appointment or learn more about neurological services, visit swgeneral.com. And thank you for listening to Southwest General Health Talk, the podcast from the specialists at Southwest General Health Center.