The benefit zone of full-endoscopic spine surgery

Abstract

Minimally invasive spine procedures have undergone rapid development during the last decade. Efforts to decrease muscle crush injuries during prolonged retraction, avoid significant soft tissue stripping and minimize bony resection are surgical principles that are employed to prevent iatrogenic instability and provide patients with decreased post-operative pain and disability. Full-endoscopic spine surgery represents a tool for the spine surgeon to provide targeted access to spinal pathology utilizing these principles. Endoscopic techniques have seen over 30 years of evolution and innovation, however, early iterations of these techniques largely focused on transforaminal lumbar microdiscectomies. Currently, endoscopic techniques are utilized for approaching pathology in the cervical, thoracic and lumbar spine. There has been a growing body of literature that not only confirms the efficacy of these procedures but also underscores the advantages these procedures offer with respect to less morbidity and safer complication profiles. Endoscopic decompressions have been utilized in the settings of degenerative spinal stenosis, spondylolisthesis, scoliosis, previous fusion, tumor and infection. Furthermore, endoscopic interbody fusion has also been utilized in the lumbar spine as technology continues to advance. As technological innovation continues to facilitate reproducible surgical technique and expand the indications for use, we believe that endoscopic spine surgical techniques will provide surgeons with a more powerful and less morbid approach to spinal pathology that ultimately elevates the standard of care when treating our patients. We present a brief review of the history of endoscopic spine surgery, an overview of current techniques and review current outcomes of endoscopic spine surgical procedures in the context of an invasiveness/complexity index to elucidate the benefit zone of these newer techniques.

The 6 T’s of Minimally Invasive Spine Surgery

“…The surgical tools and instruments used to perform MISS are rapidly evolving and include access tools such as an endoscope 4 or tubular retractors, 5 visualization and illumination with a surgical microscope or exoscope, an intraoperative imaging system with 2D and 3D navigation, 6,7 surgical planning and augmented reality software, 8 special implants, and curved, bayoneted, and extended instruments. 5 Imaging in MISS is important in order to accurately localize the pathology, avoid wrong level surgery, and insert implants properly.…”

Thoracic Endoscopic Spine Surgery: A Comprehensive Review

“…When accessing the spinal canal, an endoscopic technique also requires a smaller laminotomy than it would in an open approach. 17 Another common problem encountered by surgeons using an open dorsal or dorsolateral approach is the limited visualization of the ventral dura. Dorsal thorascopic techniques overcome this problem through the employment of an angled endoscope that can aid in ventral visualization.…”

Comparison of the effectiveness of endoscopic and open transthoracic removal of tumors of the thoracic vertebrae

“…Останнім часом дедалі частіше застосовують ендоскопічні втручання [1], перевагами яких є менша хірургічна рана, менший об'єм крововтрати, швидша реабілітація хворих. Сучасні хірургічні технології за радикальністю досягли рівня традиційних утручань [2].…”