Background:Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system.Materials and Methods:A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab's criteria after a minimum followup of 12 months and maximum up to 24 months.Results:Based on modified Macnab's criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months.Conclusion:Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.

Background:Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments.Materials and Methods:150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years). The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3), L2-L3 (n = 2), L3-L4 (n = 8), L4-L5 (n = 90), and L5-S1 (n = 47). Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments.Results:Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90%) patients had excellent to good, 12 (8%) had fair, and 2 patients (1.3%) had poor results. The complications observed were discitis in 3 patients (2%), dural tear in 4 patients (2.6%), and nerve root injury in 2 patients (1.3%). About 90% patients were able to return to light and sedentary work with an average delay of 2 weeks and normal physical activities after 2 months.Conclusion:Arthrospine system is compatible with 30° arthroscope and conventional micro-discectomy instruments. Technique minimizes approach related morbidity and provides minimal access corridor for lumbar discectomy.

Objective: Destandau’s endospine technique was initially described for lumbar disc herniation and was later applied for lumbar spinal stenosis. Favorable outcomes have been reported with this technique for lumbar degenerative pathology. This article attempts to review the literature and define the scope of Destandau’s technique in cervical and thoracic pathologies.Methods: A literature search for the keywords “Destandau” and “endospine” was performed in the PubMed, Cochrane, Scopus, Embase, and MEDLINE databases. The review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA) tool.Results: In total, 91 studies were found, out of which three studies employed Destandau’s endospine technique for cervical and thoracic pathologies. Three book chapters describing the Destandau technique in cervical pathology and intradural tumor excision were also included in the review. The technique has been successfully employed by various authors for an anterior or posterior cervical approach to disc herniation, cord decompression, and excision of intradural extra-medullary lesions of the spinal canal. No studies mentioned using the Destandau technique for thoracic disc herniation, traumatic fractures, or ossified ligamentum flavum decompression. Conclusion: Destandau’s endoscopic technique has been applied successfully in anterior and posterior cervical approaches for cervical disc herniation, myelopathy and intradural tumors, and its advantages include less pain, minimal muscle damage, shorter hospital stays, and the preservation of spinal stability/segment mobility. Further studies comparing various techniques would help choose the most patient-friendly technique for specific pathologies.

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A group of 30 patients of unstable tibial diaphyseal fractures were managed using unilateral tubular external fixator. The fixator assembly comprised a double stainless steel hollow rod with universal joints and schanz screws as principal implant. Reduction and controlled distraction or compression were achieved by means of distracterIcompressor device. Early dynamization was resorted to. The union rate was 100% with average healing time between 20 weeks for closed unstable fractures and 27 weeks for open Gustilo grade-II fractures. Minor pin tract infections accounted for majority ofthe complications. The unilateral fixator assembly permits early ambulation in unstable tibial diaphyseal fractures without sacrificing a sound anatomical result. MJAFI 1998; 54 : 319-321