Endoscopic surgery has been around for a while but its use has been fairly limited in the cervical spine. The close proximity of the blood and nerve supply to vital structures makes this a procedure with some increased risk.
First, the surgeon can use (but does not rely on) his or her knowledge of the local anatomy. Knowing where to make the incision to insert the scope is important. The surgeon must be careful not to damage the thyroid or vocal chords.
Second, a special X-ray called fluoroscopy helps guide the first channel into place. A C-arm apparatus encircles the area sending X-ray images to a computer screen for viewing.
Once the endoscopic channel is in place, then the surgeon can pass instruments down through the channel to the area of concern. A tiny TV camera on the end of the scope continues to broadcast pictures to the computer screen. The surgeon continues to navigate based on an understanding of the anatomy and both fluoroscopic and endoscopic images sent to the computer screen.