Original Article

Emerging Endoscopic Minimal Invasive Laser Spinal Surgery (lumbar, cervical and thoracic)

J Chiu

Citation

J Chiu. Emerging Endoscopic Minimal Invasive Laser Spinal Surgery (lumbar, cervical and thoracic). The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.

Abstract


Introduction: Laser Minimally Invasive Spine Surgery (MISS) was thought to be impossible and impractical not long ago, but has rapidly come of age1,2,3,4,5, due to much improved endoscopic and micro spinal surgical instruments the explosive development of bio-computer technology, digital video imaging, ultra fast virtual spino scan, and tissue modulation technology6,7. A significant percentage of spinal surgeries will be modified or replaced with laser MISS8. Therefore a new algorithm in the treatment of degenerative spinal disease is urgently needed (Table 1).








Purpose: To identify and demonstrate the laser MISS surgical techniques and treatment for herniated cervical, thoracic and lumbar discs, and degenerative spine disease; to demonstrate the current and future laser MISS related technology, and to describe potential surgical complications and their avoidance.





Material and Methods: Recent innovative endoscopic laser MISS instruments, various spinal endoscopes, 3 intra-operative digital x-ray fluoroscopy, digital video photography, various laser application, newer endoscopy for better visualization, and thermodiskoplasty (i.e. the use of the laser at low energy levels, to shrink and tighten disc material) 6,7 are described. Endoscopic laser MISS surgical techniques are demonstrated for lumbar, cervical, and thoracic spinal operations. 6,7,9,10,11 On the horizon, many digital computer aided innovations1 including surgical robotics, image guided technology and other surgical systems are also described.


A well designed digital Institutional Information System (IIS) including a Picture Archiving and Communication System (PACS),1,12and a digital 3-D imaging virtual reality system in a surgical planning laboratory1 provides precise diagnosis and pre-operative surgical planning in order to facilitate MISS process, and to provide intramural and extramural connectivity. Digital video game technology, heptic technology and surgical simulator are on the horizon13 to facilitate and to improve education, research, development, and endoscopic laser surgical training 12,13,14,15,16,17 in addition to better patient care.




Results and discussion: Laser minimally invasive spine surgery outcome has improved the overall success rate to above 91% or more (94% for one level) with less than 1% of morbidity and zero mortality as demonstrated in a recent multicenter study16. Also potential laser MISS complications and avoidance are fully discussed.




The rapid progress in endoscopic laser MISS has been facilitated by modern bio technology. There is a definite correlation between clinical findings, digital radiology, neuropsychological studies, MRI, CT, 3D virtual imaging, virtual spinal endoscopy, surgical findings and positive surgical results. Digital video game technology, heptic technology and surgical simulation will assist in the training of the minimally invasive spine surgeons13, and to shorten the learning curve. Surgical robotics and image guided technology1 for MISS are on the horizon.




Conclusion: Endoscopic laser MISS has rapidly become of age and has many obvious advantages.7,10,11,16 Digital technology assists in the advancement, development, the training, and the practice of endoscopic laser MISS for treatment of degenerative disc disease, with preservation of segmental spinal motion. This minimally invasive, less traumatic, outpatient endoscopic laser MISS treatment for cervical, lumbar and thoracic disc disease leads to excellent results, faster recovery, and significant economic savings. In the near future with the assistance of digital technology, endoscopic laser MISS applications will further provide an excellent and effective access or platform for spine arthroplasty, spinal disk replacement, artificial disk, vertebralplasty, spinal fixation/fusion, disc re-growth technology and perhaps genome therapy.

 

References

1. Chiu J, Digital Technology Assisted Minimally Invasive Spinal Surgery (MISS) for Spinal Motion Preservation. In: Lemke H.U, Vannier MN, Invamura RD, eds. Computer Assisted Radiology and Surgery. Amsterdam, San Diego, Oxford, London; Elsevier Medical Publisher; 2004, pp.461-466
2. Jaikumar, S, Kim, D, Kam, A,, History of Minimally Invasive Spine Surgery, Neurosurgery Supp 2002;51 l2:1-14, 2002
3. Chatenever D., Minimally invasive surgical visualization past, present and future. J of Minimally Invasive Spinal Technique, 2001; 1(1): 2-7.
4. Mogel, Greg, Special Assistant to Director of TATRC, Fort Detrick MD, The Future of Med informatics Technology Implementation and Digital Imaging in Spinal Surgery, 4th Global Congress on Minimally Invasive Spinal Surgery and Medicine, AAMISMS 5TH Annual Meeting, Thousand Oaks, CA, 11/19-22, 2003, Proceedings, page 11
5. Perez-Cruet MJ, Balabhadra RSV, Samartzis D, Kim D., Historical Background of Minimally Invasive Spine Surgery. In Kim D, Fessler R, Regan J, eds. Endoscopic Spine Surgery and Instrumentation. New York: Thieme Medical Publisher; December 2004: Chapter 1, pp 3-17. December 2004
6. Chiu, J., Clifford, T., Greenspan, M., Richley, R., Sison, R., Percutaneous Microdecompressive Endoscopic Cervical Discectomy with Laser Thermodiskoplasty. The Mt. Sinai J of Med, 9/2000; 67(4): 278-282.
7. Chiu, J., Anterior Endoscopic Cervical Microdiscectomy. In Kim D, Fessler R, Regan J, eds. Endoscopic Spine Surgery and Instrumentation. New York: Thieme Medical Publisher; December 2004: Chapter 5, pp 48-58. December 2004
8. Chiu, J., Savitz, MH. Use of Laser in Minimally Invasive Spinal Surgery and Pain Management. In: Kambin P, ed. Arthroscopic and Endoscopic Spinal Surgery - Text and Atlas. Second Edition. New Jersey: Humana Press; 2005: Chapter 13, pp 259-269.
9. Chiu J, Evolving Transforaminal Endoscopic Microdecompression for Herniated Lumbar Discs and Spinal Stenosis. Surg Technol Int 12/2004; XIII: pp 276-286
10. Chiu, J., Posterolateral Endoscopic Thoracic Discectomy. In Kim D, Fessler R, Regan J, eds. Endoscopic Spine Surgery and Instrumentation. New York: Thieme Medical Publisher; December 2004: Chapter 11 pp 125-136. December 2004
11. Chiu, J., Endoscopic Lumbar Foraminoplasty In Kim D, Fessler R, Regan J, eds. Endoscopic Spine Surgery and Instrumentation. New York: Thieme Medical Publisher; December 2004: Chapter 19, pp 212-229. December 2004
12. Huang, H.K., PACS, informatics, and the neurosurgery command module. J of Minimally Invasive Spinal Technique, 2001; 1(1): 62-67.
13. Rosser J, "The Impact of Video Games on Training Surgeons and Physicians in the 21st Century", presented at the Video Game/Entertainment Industry Technology and Medicine Conference '04, December 10-11, 2004, Marina Del Rey, California
14. Chiu J, Complications and Avoidance in Endoscopic Spine Surgery, presented at the North American Spine Society Minimally Invasive Spine Technique: Hands-on Course , Barrow Neurological Institute (BNI), Phoenix, AZ May 16-17, 2003
15. Haller, J., Ryken, T., Vannier, M., Image guided surgery of the spine - Case Report. J of Minimally Invasive Spinal Technique, 2001; 1(1): 87-92.
16. Chiu, J., Clifford, T., Savitz, M., Yeung, A., Batterjee, K., Destandau, J., Hoogland, T., Kambin, P., Knight, M., Lee, S.H., Leu, H., Pedachenko, E., Peterson, R., Felipe-Ramirez, J., Rezaian, A., Reuter, M., Scheffer, S., Schmidt, N., Werner, D., Shang-Li, L., Zhaomin, Z., Multicenter study of percutaneous endoscopic discectomy (lumbar, cervical, and thoracic. J of Minimally Invasive Spinal Technique, 2001; 1(1): 33-37.
17. Martin, N., Digital Integration and Informatics in the OR of the Future, 4th Global Congress on Minimally Invasive Spinal Surgery and Medicine, AAMISMS 5TH Annual Meeting, Thousand Oaks, CA, 11/19-22, 2003, Proceedings, page 5

Author Information

John C. Chiu, M.D., FRCS
Neurospine Department, California Spine Institute

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