Endoscopic Spine Surgery: A New Era in Minimally Invasive Spine Care

John K. Hong, M.D. | 4/4/2025

Back and neck pain are among the most common reasons people visit their doctor—and in severe cases, surgery may be the only way to get relief. But for years, “spine surgery” has carried a heavy reputation: long incisions, extended recovery, significant pain, and high risk of complications.

That’s rapidly changing.

Welcome to the future of spine care: Endoscopic Spine Surgery—a minimally invasive, precision-guided alternative that’s reshaping how spine conditions are treated and how quickly patients recover.

What Is Endoscopic Spine Surgery?

Endoscopic spine surgery (ESS) uses a small tube-like camera (endoscope) inserted through a tiny incision—often less than 1 cm in size—to access and treat spinal pathology such as:

• Herniated discs

• Spinal stenosis

• Foraminal narrowing

• Facet joint degeneration

• Certain types of spinal instability

Rather than cutting through muscle and soft tissue like traditional open surgery, ESS dilates and preserves the surrounding structures, minimizing damage and promoting faster recovery.

Why It’s a Game-Changer

1. Minimally Invasive by Design

ESS requires only a small incision—often no larger than a keyhole. This leads to:

• Less blood loss

• Lower infection risk

• Minimal muscle disruption

• Faster wound healing

Most procedures are done on an outpatient basis, meaning patients go home the same day.

2. Faster Recovery, Less Pain

Because there's less tissue damage, patients typically experience:

• Less postoperative pain

• Reduced need for narcotics

• Faster return to work or activity

Many patients are back on their feet within days—not weeks or months.

3. Precision with Visualization

With high-definition cameras and real-time imaging, surgeons have crystal-clear visualization of spinal structures. This allows for:

• Targeted decompression

• Precise discectomy or rhizotomy

• Reduced collateral damage

Endoscopic technology can be used for both lumbar and cervical spine procedures, and newer techniques are expanding into thoracic applications as well.

4. Ideal for High-Risk or Elderly Patients

Because of the lower physiologic stress, ESS is especially valuable for:

• Older adults

• Patients with multiple comorbidities

• Individuals seeking to avoid general anesthesia (many procedures can be performed under sedation)

  
  

5. Cost-Effective and ASC-Compatible

As healthcare shifts toward value-based care, ESS offers reduced hospital stays, fewer complications, and lower overall costs. Many procedures can be performed in ambulatory surgery centers (ASCs) with optimized efficiency and safety.

How It’s Transforming Spine Surgery

Endoscopic spine surgery isn’t just a technical upgrade—it’s a paradigm shift. Traditionally, spine surgery was the “last resort.” Today, with the right indications and in skilled hands, ESS is becoming a first-line surgical option, especially for disc herniations and localized stenosis.

It’s also expanding access to care. Patients who were previously not surgical candidates due to age or frailty now have options. And those who fear the downtime and risks of open surgery are finding relief through less invasive means.

Is It Right for You?

Endoscopic spine surgery isn’t for every condition—but it's an excellent option for many common spinal problems. Ideal candidates include those with:

• Lumbar or cervical disc herniations

• Radiculopathy (sciatica or arm pain)

• Mild to moderate spinal stenosis

• Facet joint pathology requiring targeted ablation

A consultation with a fellowship-trained interventional spine or minimally invasive spine surgeon can help determine whether ESS is appropriate for your condition.

Final Thoughts

We are in the midst of a revolution in spine care—where precision, preservation, and patient outcomes come first. Endoscopic spine surgery is leading that charge, offering safer procedures, faster recovery, and better results for many.

If you or someone you know is dealing with persistent back or neck pain and considering surgery, don’t settle for outdated methods. Ask whether an endoscopic approach could change your surgical experience—and your life.

For more information or to schedule a consultation, contact our clinic today at (435) 714-7180. Parkview has offices in Park City and Salt Lake City to conveniently serve you!

Endoscopic Medial Branch Rhizotomy: A Precision Upgrade to Conventional RFA

Dr. John K. Hong, M.D. | 4/4/2025

Chronic back pain—especially stemming from facet joint arthropathy—is one of the most common reasons patients seek interventional spine care. For decades, percutaneous radiofrequency ablation (RFA) of the medial branches has been a go-to treatment to provide lasting relief. But as with all fields in medicine, innovation continues to refine and improve outcomes.

One of the most exciting advancements in facet joint pain management is the Endoscopic Medial Branch Rhizotomy (EMBR)—a technique that enhances the precision and efficacy of medial branch neurotomy while offering a set of compelling advantages over conventional RFA.

What Is Endoscopic Medial Branch Rhizotomy?

EMBR uses a minimally invasive endoscopic approach to directly visualize and ablate the medial branch nerves that innervate the facet joints. Rather than targeting the nerve based on anatomical landmarks and fluoroscopic guidance alone (as is done in percutaneous RFA), EMBR allows for direct visualization of the target nerve through an endoscope inserted via a small cannula.

The procedure is typically performed under conscious sedation or monitored anesthesia care (MAC), and involves:

• Insertion of a working cannula under fluoroscopic guidance

• Placement of an endoscope for direct visualization

• Mechanical and thermal ablation of the medial branch

• Optional debridement of the adjacent ligament or bone for nerve exposure

  
  

How Does EMBR Compare to Conventional RFA?

1. Direct Visualization = Higher Accuracy

Traditional RFA relies on anatomical landmarks and motor/sensory stimulation to confirm proximity to the medial branch. However, variations in anatomy or post-surgical changes can make accurate targeting difficult. With EMBR, the physician sees the nerve directly and can confirm its ablation in real time.

2. More Durable Denervation

Studies suggest that EMBR may provide longer-lasting relief than conventional RFA. Why? Because the ablation is more complete—often including both thermal and mechanical disruption of the nerve. This decreases the chances of early nerve regeneration and recurrence of pain.

3. Improved Outcomes in Post-Surgical Patients

For patients with prior spinal surgery (e.g., laminectomy or fusion), altered anatomy may limit the effectiveness of traditional RFA. The endoscopic approach allows the provider to navigate around scar tissue, directly identify residual medial branches, and ablate them even in complex cases.

4. Reduced Need for Repeat Procedures

Because the ablation is more thorough, EMBR often reduces the frequency of repeat procedures. This is a welcome benefit for both the patient and the healthcare system, reducing cumulative exposure to procedural risks, imaging, and sedation.

5. Minimally Invasive and Outpatient-Friendly

Despite the use of an endoscope, EMBR remains a minimally invasive procedure. With advancements in technique and instrumentation, it can be performed in an ambulatory surgical center (ASC) setting, often with minimal recovery time and rapid return to activities.

Who Is a Good Candidate?

Ideal candidates for EMBR include:

• Patients with confirmed facet-mediated back pain via diagnostic blocks

• Individuals who have failed traditional RFA or had short-lived relief

• Patients with post-laminectomy or post-fusion syndrome

• Athletes or active individuals seeking more durable relief

• Those who want to minimize the frequency of interventional procedures

  
  

Final Thoughts

As spine care continues to evolve, EMBR represents a natural next step in the refinement of facet denervation techniques. By combining the power of direct visualization with the efficacy of precise, durable ablation, endoscopic medial branch rhizotomy offers enhanced outcomes, especially in complex or recurrent cases.

If you’re a patient struggling with facet-mediated back pain—or a provider interested in advanced interventional techniques—EMBR may be worth considering as a frontline or salvage option for long-term relief.

For more information or to schedule a consultation, contact our clinic today at (435) 714-7180. Parkview has offices in Park City and Salt Lake City to conveniently serve you!

Understanding the Causes of Lower Back Pain

Dr. John K. Hong, M.D. | 3/10/2025

Lower back pain is one of the most common health issues that people experience, affecting millions worldwide. It can range from a mild discomfort to severe, chronic pain that impacts daily life. Understanding the various causes of lower back pain can help individuals make informed decisions about treatment, lifestyle changes, and prevention.

1. Muscle or Ligament Strain

One of the most frequent causes of lower back pain is muscle or ligament strain. This can occur due to overexertion, sudden movements, lifting heavy objects incorrectly, or even poor posture. The muscles and ligaments in the lower back are essential for supporting the spine and keeping the body upright. When they are overstretched or torn, it can cause significant pain and stiffness.

2. Herniated or Bulging Discs

The spine is made up of a series of vertebrae separated by intervertebral discs, which act as cushions to absorb shocks and allow movement. A herniated or bulging disc occurs when the soft inner part of the disc pushes through the outer layer. This condition can place pressure on nearby nerves, leading to sharp pain, tingling, or numbness in the lower back, legs, and buttocks. A herniated disc is often a result of aging, wear and tear, or sudden trauma.

3. Degenerative Disc Disease

As we age, the intervertebral discs in the spine begin to lose hydration and elasticity. This leads to a condition known as degenerative disc disease, which can cause pain, stiffness, and reduced mobility. While it may sound like a severe condition, degenerative disc disease is a natural part of the aging process. However, when combined with other risk factors, it can lead to chronic pain.

4. Sciatica

Sciatica refers to pain that radiates along the sciatic nerve, which runs from the lower back down through the hips and buttocks and down each leg. The most common cause of sciatica is a herniated disc that presses on the sciatic nerve. Sciatica is often characterized by sharp, shooting pain, numbness, and tingling sensations. People with sciatica may find it difficult to sit for long periods or stand without discomfort.

5. Spinal Stenosis

Spinal stenosis occurs when the spaces within the spine narrow, putting pressure on the spinal cord and nerves. This condition typically develops in the lower back and neck as we age. Spinal stenosis can cause pain, numbness, and weakness in the lower back, as well as difficulty walking or maintaining balance.

6. Osteoarthritis

Osteoarthritis is a degenerative joint disease that affects the cartilage in the joints, including those in the spine. As the cartilage wears down, the bones in the spine can rub against each other, leading to pain, inflammation, and stiffness. Osteoarthritis can contribute to conditions like spinal stenosis, further exacerbating lower back pain.

7. Scoliosis and Other Spinal Curvatures

Scoliosis is a condition in which the spine curves abnormally to the side, creating an S- or C-shaped curve. Although scoliosis can develop during childhood or adolescence, it often becomes more noticeable and painful in adulthood. People with scoliosis may experience lower back pain due to the uneven distribution of pressure on the spine.

8. Injuries or Trauma

Accidents, falls, or other forms of trauma can lead to fractures, sprains, or other injuries to the spine. A sudden impact can cause the bones in the spine to break, which can result in acute and sometimes long-lasting pain. Even minor injuries can lead to lingering discomfort if not properly treated.

9. Poor Posture

Poor posture is one of the leading causes of lower back pain, especially for people who spend long hours sitting at a desk or in front of a screen. Slouching, hunching over, or sitting for extended periods can strain the muscles and ligaments in the lower back, leading to discomfort. Over time, poor posture can contribute to chronic pain if not corrected.

10. Lifestyle Factors

Certain lifestyle habits can contribute to lower back pain. For example:

• Obesity: Excess body weight places additional stress on the spine and can increase the risk of developing back pain.

• Sedentary Lifestyle: Lack of physical activity can weaken the muscles that support the spine, leading to pain and stiffness.

• Smoking: Smoking reduces blood flow to the lower back and can impair the healing process, making it harder for the body to recover from injuries or inflammation.

  
  

11. Stress and Mental Health

It’s well-documented that emotional and psychological stress can contribute to physical ailments, including lower back pain. Stress can lead to muscle tension, particularly in the neck, shoulders, and lower back. Chronic stress may also influence inflammatory processes in the body, leading to persistent pain.

12. Pregnancy

Pregnancy brings significant changes to the body, including the added weight of the baby and the shifting of the pelvis and spine. This can cause strain on the lower back, resulting in pain, especially in the later stages of pregnancy. Hormonal changes can also contribute to ligament relaxation, further increasing the risk of injury.

Conclusion

Lower back pain can arise from a variety of causes, ranging from poor posture to medical conditions such as arthritis or herniated discs. Recognizing the underlying cause is essential for effective treatment and prevention. If you're experiencing persistent or severe lower back pain, it's important to consult a healthcare professional for a proper diagnosis and personalized treatment plan.

Maintaining a healthy weight, practicing good posture, staying active, and avoiding excessive strain on your back are all important steps to prevent lower back pain and ensure long-term spinal health.

Parkview Pain and Regenerative Institute provides expert lower back pain care. Our goal it identify the exact cause of the pain and treat the pain directly and effectively to reduce pain and restore quality of life! Parkview serves Salt Lake City, Park City and surrounding areas. Call today for more information and to be seen within a week. (435) 714-7180