A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

Jang

2021

Self Cite

Uniportal Lumbar Endoscopic decompression can be performed through transforaminal and interlaminar route. Interlaminar lumbar endoscopic unilateral laminotomy for bilateral decompression allows good decompression of central and lateral recess of the stenotic lumbar spine region. Both over the top decompression approach and under the ligamentum flavum decompression approach method has been recently described with differing principles and approaches despite achieving the same target in decompression of spinal canal through uniportal interlaminar endoscopic route. The authors aim to share their experience and thoughts on the 2 described approaches. Retrospective clinical cohort evaluation of patients who underwent LEULBD were performed from January 2018 to December 2019 The cohort of 278 cases of LEULBD with mean age of 64 years old were evaluated. Complica-tion rate is 3.6% and reoperation was 3.6%, mean VAS improvement at 1 weeks, 3 months and final follow up were 3.06±0.66, 2.50±0.86 and 2.17±0.91 respectively, p<0.001 and ODI impro-vement at 1 weeks, 3 months and final follow up were 31.87±5.02, 27.91±6.31 and 25.32±6.44 respectively. Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression could achieve good clinical outcomes and low rate of complications with thorough understanding of endoscopic anatomy.

Section: Discussionmentioning

confidence: 99%

“…The incidence of spinal stenosis is increasing due to aging population. The demand for minimally invasive surgery, less perioperative morbidities and early mobilization drives the development of endoscopic spine surgery 6,12) . However, until endoscopic burrs were developed, endoscopic decompression was practically not easy.…”

Section: Introductionmentioning

confidence: 99%

Clinical Results And Review of Techniques of Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression (LE-ULBD) for Lumbar Stenosis

Jang

2021

Self Cite

“…In both Uniportal and Biportal ESS, the endoscopic drill needs to be water resistant, compatible in water based surgical environment 54,56) . Biportal ESS uses standard working length drill is similar to microscopic surgery, a straight handle is recommended and the surgeon holds the drill on right hand only most of the time during surgery.…”

Section: Endoscopic Drill and Energy Systemmentioning

confidence: 99%

“…There is a growing trend and demand for minimally invasive spine surgery and in particular endoscopic spine surgery 29) . The common goal of achieving maximal amount of benefit with the least amount of soft tissue damages is the main aim of endoscopic spine surgery 30,54) . The advantages of endoscopic spine surgery is provided by water irrigation surgery, improvements in visualization with magnification of spinal structures, safe delivery of energy and spinal instruments to target tissues to minimize collateral damages to tissues 13) .…”

Section: Introductionmentioning

confidence: 99%

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

Choi

et al. 2021

Self Cite

There is increasing trend of spine surgeries performed with uniportal and biportal endoscopic spine surgery. Despite its good outcomes and supportive literature, the proportion of spine surgeons regularly doing endoscopic spine surgeries is relatively low. The main limitation is the steep learning curve in the early phase of endoscopic spine surgeries practice. There is paucity of literature in discussion of tips in overcoming these 2 schools of endoscopic spine surgery practice. In this tips and tricks overview, the authors highlights the key differences these 2 main school of endoscopic spine surgeries practice with specific discussions pertaining to "BIPORTALS": the areas of basic medium of surgery, instruments for visualization and working, placement of portal(s), outflow of fluids, route of approach, technical challenges, anatomical challenges, location of lens and light source and start point to work. A ladder of progression of endoscopic spine surgery is proposed to effectively ease into the practice of endoscopic spine surgery.

“…Author speculated that the potential reason for the relatively high rate of interlaminar approach postoperative complications might be the excessive retraction of the neural structure. However, these complications in endoscopy can be avoided with the accumulation of experience and continuous improve surgical skill for individual surgeons 57) ; The patch-blocking dura repair technique used in open surgery can be transferred by the application of collagen-fibrin sealant patch in endoscopy for small incidental durotomy; Setting proper water pressure of irrigation system can ensure the normal cerebrospinal fluid flows while discover the bleeding points in time; Before removing of the working cannula, the pulsation of the dural sac should be detected and check the freedom of the nerve root carefully, then performing sufficient hemostasis to prevent postoperative hematoma.…”

Section: Complicationmentioning

confidence: 99%

A Review of Full-endoscopic Interlaminar Discectomy for Lumbar Disc Disease: A Historical and Technical Overview

Liu

Chen³

et al. 2021

Lumbar disc disease is an age or trauma-related disc injury with the clinical symptoms such as lower back pain or sciatica. Surgical treatment is the reliable and effective solution only if the symptoms grow progressively worse and conservative treatments fail. The purpose of spinal surgery is to remove the real pain generator and maintain physiological spinal alignment. Traditionally, patients after discectomy tend to experience the risk of postoperative intervertebral disc degeneration with intractable low back pain. Therefore, the minimally invasive techniques have rapidly developed in the past decades and brought revolutionary progress on techniques modification. Herein, we report the historical overview of the interlaminar fullendoscopic lumbar discectomy and technical evolution based on the review of literature.