Endoscopic spine surgery – Current trends, future, and outlook

It is estimated that about more than 280 million individuals worldwide are suffering from degenerative spinal conditions – presenting mainly as back pain, i.e., about 3.8 percent of the world population. To put in perspective, the people suffering from heart problems, cancer, and diabetes worldwide are 300 million, 100 million, and 500 million reported annually.

Thus degenerative spinal condition is among the third-most common problems affecting individuals and is the single most factor causing leave of absence from work in developed and developing countries.

This is especially worrisome in those countries, which either have a larger elderly population or a younger population like India.

Since the spinal problems affect more across the two ends of the age spectrum, it is important to have a treatment, which can give effective long-term management, early recovery, and minimal hospitalization, but also at the same time is cost effective.

Spinal surgery done 3–4 decades ago was done through routine open approaches, and this was always terrifying to many individuals due to its morbidity and poor outcomes in many cases. Thus there was always an outlook for safer, simpler, and more precise spinal surgeries. This led to the development of minimally invasive and endoscopic spine surgeries.

Endoscopic spine surgeries are spinal surgeries done through small keyhole incisions, instead of the traditional open surgery. It is a further advancement over the traditional open surgery techniques.

The benefits are smaller incisions, less muscle damage, less blood loss, reduced postoperative pain and stay, thus benefitting the elderly and the working-class population the most.

Presently the market share of endoscopic procedures is around USD 560 million, which is dominated mainly by procedures done in the North America and the US, in particular. This is followed by Europe and then the Asia-Pacific region. Within Asia region, Japan, China, and South Korea are dominating the growth of endoscopic spine surgery market.

India is taking a lead in this market. Most of the endoscopy procedures in India are commonly being done in Tier-II and Tier-III, cities compared to metro and Tier-I cities.

The reason for this number of endoscopic spine surgery procedures more in smaller cities is the cost of doing these procedures and the patient population. With less cost of inventory and larger population flow in smaller cities, these procedures are more beneficial at present in smaller cities.

As more patients become aware of these procedures and more surgeons become trained in these techniques, the trend will shift to metro cities also. The benefits that Tier-I cities offer in India are:

• Better insurance coverage, thus a larger population base can be covered.
• Better operation theater facilities and hospital care.

It is estimated that the global market of endoscopy procedures and equipment will reach USD 1.1 billion by 2031, and almost 30–35 percent share will be by Asia-Pacific region. India will be at the forefront of the Asian market due to mainly two reasons:

• Cost and ease of getting these procedures done is better in India compared to other Asian countries. Most of the spinal procedures being done in India are at one-fourths the cost of US and Europe and with the same equipment and techniques. Also there is not much of waiting time for these procedures in India unlike in the US.
• Most of these endoscopes and their supporting equipment are being made in India locally, which are at one-tenth of the international costs, and which have the same finishing and user capability.
• The pool of spinal surgeons from India undergoing training in these procedures is large, making a larger number of trained persons performing these procedures.

So as our Prime Minister Shri Narendra Modi says Make in India, with the benefit of local equipment and large pool of trained surgeons, India will be at the forefront of providing latest endoscopic spinal surgery at par with the international centers.