A better, less invasive way to do spine surgery
By Roberta Cannon, RN
Larry Thayer has experienced chronic back pain for a number of years, but things took a turn for the worse when he woke up one morning last fall with agonizing pain shooting down his right leg.
“Literally overnight, I went from tolerating the pain in my back to having excruciating pain in my right leg,” said Thayer. “I spent four days in Cape Cod Hospital having tests and medications for pain.”
His final test was a CT myelogram, a form of X-ray that includes an injection of contrast (a special dye) into the spine to evaluate the spinal cord, nerve roots and spinal lining.
Paul Houle, MD, FAANS, a neurosurgeon with Cape Cod Healthcare Neurosurgery in Hyannis saw Thayer in the hospital, explained his test results and recommended endoscopic spine surgery.
“Spine surgery is kind of a scary thing to think about,” said Thayer. “But one of the things I liked about Dr. Houle is he instilled a lot of confidence in terms of what he was going to do, how he was going to do it and what the recovery would entail, which was very helpful.”
Evolution to Endoscopic Spine Surgery
Dr. Houle has been performing minimally invasive spine surgery (MISS) for 23 years. Unlike traditional (open) spine surgery that requires long incisions and taking the spine completely apart, the minimally invasive approach uses smaller incisions and avoids significant damage to muscles surrounding the spine. It also results in a faster recovery.
But now Dr. Houle has evolved from doing minimally invasive spine surgery to an even more minimalist approach, known as endoscopic spine surgery. Unlike minimally invasive surgery that requires small incisions of about two inches and requires a few days of hospitalization, endoscopic spine surgery entails much smaller incisions and same-day discharge to home.
“With endoscopic spine surgery (ESS), the incision is the size of a number 2 pencil eraser with a local anesthetic and sedation, and the patient goes home the same day,” he said.
“I continue to do traditional general neurosurgeries, but I find I do fewer big spine surgeries because I can take care of many spinal conditions that used to require traditional big open spinal surgery by doing very small endoscopic surgery.”
Dr. Houle, who recently performed endoscopic spine surgery on a triathlete who flew in from Phoenix for the procedure, is doing endoscopic spine surgery at Cape Cod Hospital with the brand new Arthrex working channel endoscope with the 4K high-definition Synergy Vision™ camera system.
Arthrex technologies are engineered to preserve normal anatomy, reduce postoperative pain and accelerate recovery. Dr. Houle is an instructor for the company and, at the time of this writing, was teaching 24 orthopedic and neurospine surgical fellows how to do the endoscopic surgery.
According to the National Library of Medicine, endoscopic spine surgery has grown rapidly over the past 30 years and is now being used for whole spine surgery, including the cervical and thoracic spine.
Dr. Houle recently did transforaminal endoscopic thoracic discectomy surgery using specialty instruments inserted down an endoscope to remove a disc. The surgery was done using local anesthesia and the patient was able to go home the same day.
The traditional surgery to remove a disc in the thoracic spine (center of upper and middle back) area would have required a large open incision into the chest or back, performed by a thoracic surgeon and the patient would have needed a chest tube to drain extra fluid, air or blood from the chest, and a hospital stay in the intensive care unit for a couple of days.
Other conditions endoscopic spine surgery can treat are herniated discs, spinal stenosis, spinal fusion and some degenerative disc disease.
Reflecting on Surgery
Thayer's spine surgery in December included a lumbar discectomy and foraminotomy to remove bone spurs near the disc.
“I had the procedure, and it was incredibly easy and light years ahead of the last back surgery I had years ago,” he said. “On the day of this surgery, I was probably at the hospital a total of four hours between the time I checked in and when I left to go home. My leg pain is gone, and I am doing much better than before my surgery. I still have some back pain but I am exercising to build up my legs and the rest of my body to help my back. I would recommend this surgery to anyone who needs it.”
“With endoscopic spine surgery, there is less pain postoperatively, very little need for narcotic/opioid pain medication and it’s much easier on the patient with a quicker return to normal activities and a quicker return to work,” said Dr. Houle.
Dr. Houle shares his expertise and passion for endoscopic surgery with other neurosurgeons, fellows, interns and residents from around the United States, and has lectured and given grand rounds at Harvard and Dartmouth Universities on the topic.
“Fellows and attending physicians have come and observed my surgeries at Cape Cod Hospital and have incorporated what they’ve learned from me into their own practices,” said Dr. Houle.
He has also traveled to Europe and Asia and has performed surgeries in Portugal and the Azores.
“Teaching is a lot of fun and I enjoy doing it.” said Dr. Houle.
View Physician Profile
Originally published on Cape Cod Health News, June 10, 2025
“Literally overnight, I went from tolerating the pain in my back to having excruciating pain in my right leg,” said Thayer. “I spent four days in Cape Cod Hospital having tests and medications for pain.”
His final test was a CT myelogram, a form of X-ray that includes an injection of contrast (a special dye) into the spine to evaluate the spinal cord, nerve roots and spinal lining.
Paul Houle, MD, FAANS, a neurosurgeon with Cape Cod Healthcare Neurosurgery in Hyannis saw Thayer in the hospital, explained his test results and recommended endoscopic spine surgery.
“Spine surgery is kind of a scary thing to think about,” said Thayer. “But one of the things I liked about Dr. Houle is he instilled a lot of confidence in terms of what he was going to do, how he was going to do it and what the recovery would entail, which was very helpful.”
Evolution to Endoscopic Spine Surgery
Dr. Houle has been performing minimally invasive spine surgery (MISS) for 23 years. Unlike traditional (open) spine surgery that requires long incisions and taking the spine completely apart, the minimally invasive approach uses smaller incisions and avoids significant damage to muscles surrounding the spine. It also results in a faster recovery.
But now Dr. Houle has evolved from doing minimally invasive spine surgery to an even more minimalist approach, known as endoscopic spine surgery. Unlike minimally invasive surgery that requires small incisions of about two inches and requires a few days of hospitalization, endoscopic spine surgery entails much smaller incisions and same-day discharge to home.
“With endoscopic spine surgery (ESS), the incision is the size of a number 2 pencil eraser with a local anesthetic and sedation, and the patient goes home the same day,” he said.
“I continue to do traditional general neurosurgeries, but I find I do fewer big spine surgeries because I can take care of many spinal conditions that used to require traditional big open spinal surgery by doing very small endoscopic surgery.”
Dr. Houle, who recently performed endoscopic spine surgery on a triathlete who flew in from Phoenix for the procedure, is doing endoscopic spine surgery at Cape Cod Hospital with the brand new Arthrex working channel endoscope with the 4K high-definition Synergy Vision™ camera system.
Arthrex technologies are engineered to preserve normal anatomy, reduce postoperative pain and accelerate recovery. Dr. Houle is an instructor for the company and, at the time of this writing, was teaching 24 orthopedic and neurospine surgical fellows how to do the endoscopic surgery.
According to the National Library of Medicine, endoscopic spine surgery has grown rapidly over the past 30 years and is now being used for whole spine surgery, including the cervical and thoracic spine.
Dr. Houle recently did transforaminal endoscopic thoracic discectomy surgery using specialty instruments inserted down an endoscope to remove a disc. The surgery was done using local anesthesia and the patient was able to go home the same day.
The traditional surgery to remove a disc in the thoracic spine (center of upper and middle back) area would have required a large open incision into the chest or back, performed by a thoracic surgeon and the patient would have needed a chest tube to drain extra fluid, air or blood from the chest, and a hospital stay in the intensive care unit for a couple of days.
Other conditions endoscopic spine surgery can treat are herniated discs, spinal stenosis, spinal fusion and some degenerative disc disease.
Reflecting on Surgery
Thayer's spine surgery in December included a lumbar discectomy and foraminotomy to remove bone spurs near the disc.
“I had the procedure, and it was incredibly easy and light years ahead of the last back surgery I had years ago,” he said. “On the day of this surgery, I was probably at the hospital a total of four hours between the time I checked in and when I left to go home. My leg pain is gone, and I am doing much better than before my surgery. I still have some back pain but I am exercising to build up my legs and the rest of my body to help my back. I would recommend this surgery to anyone who needs it.”
“With endoscopic spine surgery, there is less pain postoperatively, very little need for narcotic/opioid pain medication and it’s much easier on the patient with a quicker return to normal activities and a quicker return to work,” said Dr. Houle.
Dr. Houle shares his expertise and passion for endoscopic surgery with other neurosurgeons, fellows, interns and residents from around the United States, and has lectured and given grand rounds at Harvard and Dartmouth Universities on the topic.
“Fellows and attending physicians have come and observed my surgeries at Cape Cod Hospital and have incorporated what they’ve learned from me into their own practices,” said Dr. Houle.
He has also traveled to Europe and Asia and has performed surgeries in Portugal and the Azores.
“Teaching is a lot of fun and I enjoy doing it.” said Dr. Houle.
View Physician Profile
Originally published on Cape Cod Health News, June 10, 2025