Enhancing Precision: The Application of Exoscope Technology in Spine Surgery

Introduction: Minimally invasive surgeries (MIS) are becoming increasingly popular techniques for spinal decompression as they reduce postoperative complications such as recovery time, blood loss, pain, scarring, and hospital stay. Unlike conventional microscopes used in neurological surgery, which can lead to surgeon fatigue and poor ergonomics, the exoscope offers surgeons and their teams a highly detailed view of the surgical field in neutral or upright position. This improves precision, fosters stronger collaboration, and enhances patient outcomes. In this case series, we present the successful use of an exoscope in three posterior decompression surgeries to alleviate pain from lumbar radiculopathy, and one thoracic myelopathy case.

Methods: A robotic exoscope was used by the surgical team for four patients undergoing spinal decompression surgeries. The team analyzed clinical and surgical data to evaluate the exoscope’s utility in spinal surgeries.

Results: Three patients (75%) had lumbar radiculopathy while one patient (25%) presented with thoracic myelopathy and progressive pain. Three patients underwent a posterior decompression, with the exoscope enhancing visualization during the procedure and microdissection, whereas one patient underwent a lateral thoracic retropleural MIS discectomy. In all patients, the exoscope enabled adequate decompression of the required anatomical areas, namely the lateral recess, traversing nerve roots, and central thecal sac. It enhanced visualization, depth perception, collaboration, and overall surgical convenience. There were no surgical complications or intraoperative neuromonitoring issues, and at two-week follow-up, all patients reported reduced preoperative symptoms.

Conclusion : Three-dimensional robotic exoscopes were proven to be extremely beneficial in high-precision procedures like microdissection and decompression. The exoscope enhanced visualization for the surgical team, leading to greater precision and unremarkable postoperative outcomes.