Ultra Minimally Invasive Spine Surgery, also known as Endoscopic Spine Surgery (ESS), stands as an innovative approach to spinal care, distinguishing itself from both Minimally Invasive Spine Surgery (MISS) and traditional open spine surgery through its utilization of cutting-edge techniques and equipment. While MISS employs tissue-sparing methods, often facilitated by specialized retractors, ESS takes this a step further by integrating endoscopic tools with a scope featuring a camera tip. This pivotal advancement results in notably smaller incisions and diminished tissue trauma compared to MISS. With superior visualization capabilities for surgeons and expedited recovery times for patients, ESS emerges as a transformative solution for a spectrum of spinal conditions, including herniated discs, spinal stenosis, and various degenerative spine ailments.  

1. Preoperative Evaluation: Comprehensive patient assessment, encompassing medical history, physical examination, and diagnostic imaging (MRI or CT scans), guides surgical planning.
2. Anesthesia Administration: ESS is performed under either general anesthesia or local anesthesia with sedation, tailored to the specifics of the procedure and patient requirements.
3. Incision and Access: Small incisions, typically less than a quarter of an inch, are made at the targeted area of the spine, aided by real-time X-ray guidance. A guide wire or dilator is introduced to establish a pathway to the affected spinal region.
4. Endoscope Insertion: A tubular retractor is inserted through the dilated pathway, creating a channel to the spine. The endoscope, housing a camera and light source, is subsequently introduced through the tubular retractor.
5. Visualization: The endoscope provides a magnified, illuminated view of the spinal structures on a monitor, facilitating real-time navigation and visualization of the surgical site.
6. Treatment or Correction: Surgical instruments, such as probes, graspers, or shavers, are introduced through additional channels in the tubular retractor, enabling the performance of necessary procedures. This may include the removal of herniated discs, decompression of nerve roots, or stabilization of the spine.
7. Closure: Following completion of the procedure, instruments are removed, and the small incision is closed, typically with skin glue.
8. Recovery: Patients are monitored postoperatively, with many able to return home the same day, contingent upon the complexity of the procedure and individual patient factors. The minimally invasive nature of ESS often facilitates a swifter recovery compared to traditional open surgery.
9. Postoperative Care: Patients receive comprehensive instructions for postoperative care, encompassing activity restrictions, medication management, and follow-up appointments as necessary.

Dr. Patrick Kim is a fellowship-trained neurosurgeon specializing in minimally invasive endoscopic spine surgery. He received his medical degree from LSU New Orleans and completed his residency at the University of Mississippi Medical Center. Subsequently, he pursued a fellowship in endoscopic spine surgery at University of Washington Harborview Medical Center.

As the region’s first fellowship-trained endoscopic spine surgeon, he is dedicated to introducing new techniques aimed at achieving quicker recovery and minimizing complications following spine surgery. He currently serves as an assistant professor within the Department of Neurosurgery, where he is passionately dedicated to educating and mentoring residents, actively contributing to the advancement of minimally invasive spine surgery. He shares his expertise and knowledge of endoscopic spine surgical techniques with fellow surgeons and serves as a reviewer for the World Neurosurgery Journal and the Journal of Minimally Invasive Spine Surgery and Techniques.