Endoscopic Spine Surgery

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.

Trans-foraminal endoscopic uniportal decompression in degenerative lumbar spondylolisthesis: a technical and case report

“…Conventional non-fusion decompression surgery by MLD does good decompression but with increased posterior access-related traumatization in comparison to endoscopic techniques [2]. PIELD is also a further minimal access surgery possible [1]. PTELD can achieve the ventral decompression without damaging the posterior compartment stabilizing structures [1].…”

“…Spine surgery has seen a significant progress from conventional open surgery to MISF. In today's world of percutaneous endoscopic spine surgery, PTELD and PIELD are the most minimalist options [1].…”

“…PTELD has significant advantages like a minimum surgical insult to the back muscles, less trauma, loss of blood, decreased hospital stays and speedy recovery, conservation of mobility of operated segment, and high patient satisfaction avoiding complications of fusions and general anesthesia. On the other hand, contraindications of PTELD are extensive-migrated disc, spinal stenosis, spondylolisthesis, cauda equina syndrome, patients with long iliac wings, extensive disc calcification, recurrent disc herniation, and involvement of more than one level [1,2]. But these all contraindications are now getting challenged by pioneers and getting reported sporadically [3][4][5].…”

The Value of a Synthetic Model-based Training Lab to Increase Proficiency with Endoscopic Approaches to the Spine

“…There has been significant progress in the development of endoscopic techniques to treat spinal pathology over the past few decades [1]. While these surgeries were initially limited to decompressive procedures, endoscopic-assisted fusion surgeries are now gaining increasing popularity [2][3][4][5][6][7][8][9].…”

“…These approaches offer the same benefit as traditional open approaches with reduced blood loss, decreased postoperative pain, and earlier discharge [2,10,11]. Nevertheless, the steep learning curve associated with these procedures has been well outlined in the literature and is likely one of the greatest barriers to more widespread acceptance of these 1 1 2 1 techniques.…”