Full-Endoscopic Interlaminar Lumbar Disc Surgery: Technical Development And Clinical Facts Since 1999
S Ruetten. Full-Endoscopic Interlaminar Lumbar Disc Surgery: Technical Development And Clinical Facts Since 1999. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.
The therapy of degenerative diseases of the lumbar spine involves both medical and socioeconomic problems. A surgical procedure may be necessary if conservative measures have been exhausted and states of exacerbated pain or neurological deficits persist. Despite good therapeutic results with conventional operations, there may be consecutive damage due to traumatization. Thus, it is important to continuously improve these procedures. Taking existing quality standards into account, the objectives must be to minimize operation-induced traumatization and negative long-term sequelae. Current research results and technical innovations must be critically applied in order to guarantee the best-possible treatment strategies. Minimal-invasive techniques can reduce tissue damage and its consequences. Endoscopic operations under continuous fluid flow bring advantages which raise these procedures in many areas to the standard level. Lumbar transforaminal procedures with posterolateral access have been used for more than 20 years. The work area is predominately intradiscal and intra- and extraforaminal. With the new developed lateral transforaminal access the spinal canal can be reached more sufficient under direct and continuous visualization. But the bony perimeter of the foramen limits the mobility and resection of dislocated herniations and the pelvis may block access to the lower levels. Thus there exist limitations to the transforaminal procedure. To enable the operation of pathologies be limited with the transforaminal technique a full-endoscopic interlaminar access has been developed since 1999. Problems arose technically from small and not actively-flexible instruments coupled with a small intraendoscopic work canal. Insurmountable difficulties could arise in the resection of hard tissue, the anatomic access, the mobility and the elevated recurrence rate. New optics with an intraendoscopic 4.2-mm work canal and corresponding instruments, as well as shavers and burrs were developed with the objective of permitting full-endoscopic operating under continuous visual control.
Considering the indication criteria, now the combination of posterolateral and lateral transforaminal and the interlaminar approaches with the new developed endoscopes and instruments provides sufficient full-endoscopic decompression under visual control of lumbar disc herniations located within the spinal canal or intra- and extraforaminal. The results are equal to that of conventional procedures, but with all the advantages of a truly minimally-invasive procedure. In addition due to the possibility of resect bone in a sufficient way with the new instruments and burrs the indication is broadened with respect to techniques for spinal canal decompression. Further indications can be facet cysts, fusions and infections of the disc. But the technical development has not yet been completed, and there remain clear indications and limitations. However, total avoidance of known problems in spinal surgery can hardly be imagined. In addition, open procedures will remain as indispensable in the future as they currently are. At the moment the full-endoscopic procedures are estimated as a sufficient supplementation and alternative inside the complete spectrum of spine surgery.