J Korean Neurosurg Soc.  2017 Sep;60(5):485-497. 10.3340/jkns.2017.0203.004.

Endoscopic Spine Surgery

• Choi G
• Pophale CS
• Patel B
• Uniyal P

• KMID: 2457954
• DOI: http://doi.org/10.3340/jkns.2017.0203.004

Abstract

Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

Keyword

Endoscopic spine surgery; Percutaneous endoscopic lumbar discectomy; Percutaneous endoscopic cervical discectomy; Percutaneous endoscopic posterior cervical foraminotomy; Percutaneous endoscopic thoracic discectomy

MeSH Terms

Adolescent
Athletes
Cicatrix
Constriction, Pathologic
Diagnosis
Diskectomy
Diskectomy, Percutaneous
Endoscopy
Fibrosis
Foraminotomy
Humans
Intervertebral Disc Chemolysis
Length of Stay
Lumbosacral Region
Magnetic Resonance Imaging
Quality of Life
Spinal Canal
Spinal Dysraphism
Spine*
Sports

Figure

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  Fig. 1 Needle positioning (A) anteroposterior and (B) lateral view.

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  Fig. 2 Discography.

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  Fig. 3 Guide wire and obturator insertion.

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  Fig. 4 Cannula positioning (A) anteroposterior and (B) lateral view.

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  Fig. 5 (A and B) Endoscopic view.

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  Fig. 6 Preoperative MRI. (A) Sagittal and (B) axial view. MRI: magnetic resonance imaging.

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  Fig. 7 Post-operative MRI. (A) Sagittal view and (B) axial view. MRI: magnetic resonance imaging.

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  Fig. 8 C-arm positioning of cannula.

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  Fig. 9 Identification of two layers of the ligamentum flavum.

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  Fig. 10 Identification of Epidural fat and movements disc herniation.

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  Fig. 11 End of decompression (free of the nerve roots).

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  Fig. 12 Patient and C-arm positioning with level marking.

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  Fig. 13 Needle insertion.

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  Fig. 14 Discography.

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  Fig. 15 Final position of cannula.

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  Fig. 16 Endoscope insertion.

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  Fig. 17 Use of Ho: YAG laser to make annular window.

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  Fig. 18 End of decompression.

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  Fig. 19 Patient positioning.

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  Fig. 20 Level marking.

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  Fig. 21 Needle insertion.

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  Fig. 22 Passage of serial dilators.

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  Fig. 23 Final positioning of cannula.

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  Fig. 24 Endoscopic view of facet (‘V’ shape area).

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  Fig. 25 Use of burr and kerrison punch for decompression.

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  Fig. 26 Use of burr and kerrison punch for decompression.

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  Fig. 27 Showing endoscopic approach to the thoracic spine.

Reference

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