by Jill Clendening
Raymond Gardocki, MD, associate professor of Orthopaedic Surgery, has joined Vanderbilt University Medical Center, where he will provide outpatient, endoscopic spine procedures expected to minimize post-surgical pain and reduce recovery time for adult patients with degenerative spine conditions.
Gardocki previously practiced at Campbell Clinic Orthopedics in Memphis, Tennessee, where he fully incorporated endoscopic spine procedures into his practice in 2017. He is now a sought-after educator to train other surgeons throughout the country in minimally invasive, endoscopic techniques. He is a part of the Vanderbilt Spine Center and is seeing patients at Vanderbilt Orthopaedics Franklin.
“Evaluations for spine and back problems are increasingly common in our aging population, some of which require surgical intervention. Therefore, we are aware of the need to add to our surgical spine services. We are especially pleased to be able to offer our patients the option of endoscopic procedures when surgical intervention is necessary. With the addition of Dr. Gardocki, the Vanderbilt Spine Center has added a leader in this newly emerging discipline to offer to our patients,” said C. Wright Pinson, MBA, MD, Deputy Chief Executive Officer and Chief Health System Officer, for Vanderbilt University Medical Center.
Endoscopic surgical approaches have been used for decades to treat other areas of the body, such as for arthroscopy to diagnose and treat joint conditions. Endoscopic spine surgery has been widely adopted in Europe and Asia, and with recent advances in optics and surgical tools, Gardocki predicts the practice will also expand in the United States. VUMC has a full suite of endoscopic equipment to support cervical, thoracic, and lumbar discectomies and decompressions, as well as lumbar interbody fusions to stabilize the spine.
“Few surgeons in the United States can boast Dr. Gardocki’s experience with percutaneous and endoscopic spinal procedures,” said Jacob Schwarz, MD, assistant professor of Neurological Surgery and executive medical director of the Vanderbilt Spine Center. “For carefully selected patients, these techniques offer exciting opportunities to improve their troublesome symptoms with minimal recovery time. We are fortunate to have him join the Vanderbilt Spine Center.”
Endoscopic spine surgery involves use of a pencil-sized cannula or tube through which an endoscope is inserted. The endoscope allows clear visualization of the surgical field. Endoscopic instruments are inserted through the working channel of the scope to perform procedures.
In contrast to traditional spine procedures with larger, open incisions, endoscopic procedures cause less damage to surrounding skin, muscle, and soft tissue, which means reduced post-surgery pain and inflammation. Because of this, little or no pain medication is necessary, Gardocki said.
“An endoscopic spine procedure adds value for the patient because they have less pain and a faster recovery, and it adds value to society because it reduces ancillary costs and overall health care costs,” he said. “These are direct-visualized procedures where you can see all of the structures and the anatomy so you can address the pathology. You’re doing everything essentially through a straw rather than through a larger wound.”
The endoscopic spine procedures are typically performed with conscious sedation rather than general anesthesia, which means patients avoid common side effects from general anesthesia such as nausea. Following surgery, patients spend about an hour in recovery, going home with just a dab of surgical glue covering a centimeter-long incision.
Since patients are typically awake while he’s performing procedures, Gardocki has even had patients express elation about their immediate decrease in pain as he relieves pressure from the spinal nerves.
“That’s one of those things I still haven’t gotten used to, and it still blows my mind,” he said.
Spinal images can often suggest complex problems but listening to a patient’s chief complaints can sometimes indicate less complicated issues, Gardocki said. If symptoms are eased after a diagnostic epidural steroid injection, which he often performs himself during initial evaluations, there is a good chance an endoscopic rather than open procedure is the better choice.
“You have to pinpoint the complaint on the front end – identify the specific neurological signs and symptoms — and see if you can localize the pathology to one or two levels of the spine,” he said. “The good news is that many spine surgery patients fall in this category.”
If an individual is not a candidate for an endoscopic procedure, they are referred to other surgeons on the team at the Vanderbilt Spine Center for skilled care.
VUMC’s strong research infrastructure and analytical talent in place to support investigations were a drawing point for relocating to Nashville, Gardocki said. He plans to establish an endoscopic spine surgery registry so outcomes following procedures can be documented longitudinally. This can further validate the procedures and could lead to additional practice improvements, he said.
An Orthopaedic Spine Fellowship has been established at the Vanderbilt Spine Center with the first fellow beginning in 2021, and Gardocki is eager to train fellows on endoscopic techniques.
Gardocki’s not the only physician in his household. His wife, Eunice Huang, MD, was recruited to join the faculty at Monroe Carrell Jr. Children’s Hospital at Vanderbilt, where she serves now as associate surgeon-in-chief and chief surgical quality and innovations officer, as well as professor and vice chair of Clinical Services for the Department of Pediatric Surgery. The couple has three sons.