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.

Navigation Techniques in Endoscopic Spine Surgery

“…ICT-Nav allows for improved radiographic visualization of bony and soft tissue anatomy adjacent to the trajectory of approach thanks to the application of CT while maintaining tiny incisions. These capabilities have allowed spine surgeons to apply computer-assisted MIS for a myriad of procedures, including but not limited to pedicle screw fixation, transforaminal lumbar interbody fusion (TLIF), lateral/oblique lumbar interbody fusion (LLIF/OLIF), and vertebroplasty/kyphoplasty [ 1 , 41 ]. Improved pedicle screw accuracy using ICT-Nav as compared to fluoroscopy has been replicated in MIS as well [ 42 ].…”

“…The authors reported high-quality clinical outcomes without surgical complications [ 50 ]. Nonetheless, there is a lack of literature comparing the relative effectiveness of navigation within endoscopic spine surgery against nonnavigated procedures [ 1 ]. As a result, future research comparing navigated versus nonnavigated approaches in ESS across a range of indications is needed; primary outcomes must include clinical benefit and radiation exposure to the operating room staff and patients, as well as cost.…”

“…Endoscopic approaches generally leverage natural anatomical corridors to gain access to spinal pathology in an ultraminimally invasive fashion. They have been successfully employed to accomplish various spinal procedures across the cervical, thoracic, and lumbar spine [ 1 ]. These procedures include but are not limited to discectomies, decompressions, and fusions [ 1 , 2 ].…”

“…They have been successfully employed to accomplish various spinal procedures across the cervical, thoracic, and lumbar spine [ 1 ]. These procedures include but are not limited to discectomies, decompressions, and fusions [ 1 , 2 ]. The two most common ESS approaches to percutaneous endoscopic lumbar surgery (PELS) are transforaminal PELS (tPELS) and interlaminar PELS (iPELS).…”

“…Navigation, via optical or electromagnetic mediums, potentially affords the spine surgeon superior localization of the pathology and intraoperative confirmation of pathology resolution. The use of navigation may allow for easier adoption by trainees who will likely use ESS in their future practices given its growing popularity and range of indications [ 1 , 7 ]. In addition, for tPELS, optimal positioning of the working channel is crucial to avoid operative complications such as injury to the exiting nerve root or blood vessels and to treat foraminal stenosis or herniated discs effectively [ 8 ].…”