History And Evolution Of Arthroscopic & Endoscopic Lumbar Disc Surgery: The U.S. Experience
P Kambin. History And Evolution Of Arthroscopic & Endoscopic Lumbar Disc Surgery: The U.S. Experience. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.
The concept of minimally invasive spine surgery (MISS) was formed in the 1970's by those of us who had witnessed long term complications of extensive exposure of the surgical site and disregard of the integrity of the normal anatomical structures during spinal surgery. The contributions of Lyman Smith, Professor Hijikata, Professor Schreiber and Professor Leu in the field of MISS deserve recognition.
My personal interest in MISS was ignited by reported satisfactory results via chemoneucleolysis for the treatment of herniated lumbar discs as early as 1963. In the early seventies with permission of the Board of Governors of our institution we began to experiment with mechanical nuclear debulking via the available Craig cannula. By 1973 when I was working and teaching at The Graduate Hospital, University of Pennsylvania, there was a demand for objective demonstration of the effectiveness of central nuclear resection for the treatment of herniated lumbar disc. Therefore I combined the surgical exposure of the herniation site and the traversing nerve root with the evacuation of nuclear tissue via a Craig cannula that was inserted dorsolaterally.
This experimental work was followed by a number of anatomical and pathological studies that was subsequently published. The above investigations lead me to the conclusion that the removal of the symptom producing disc herniations via an intradiscal access required the use of a larger diameter cannula that could permit passage of upbitting and deflecting instruments to access and withdraw the herniated disc fragments from the spinal canal.
Our first prototype instruments were produced in 1980 and lead to the first publication on this subject in western literature in 1981. Subsequently we published on periannular anatomy and identified the triangular working zone adjacent to the spinal canal as a safe zone for docking of the cannula and instruments. The description of radiographic landmarks of TWZ assisted surgeons to properly position the cannula while protected both the traversing and exiting nerve roots. In 1991 I had the privilege of publishing the first textbook on MISS in which we were able to demonstrate the arthroscopic and endoscopic appearance of various anatomical structures during surgery.
The horizon of MISS gradually expanded to subligamentous and transforaminal access to the sequestered disc herniation. Decompression of lateral recess stenosis, nuclear replacement, anterior column stabilization, percutaneous insertion of pedicular screws, endoscopic laminotomy and foraminotomy and the treatment of a variety of spinal disorders followed.
The contributions of many investigators to the posterolateral access namely Jim Reynolds, Jonathan Schaffer, Anthony Yeung and John Chiu are appreciated. The work of Richard Fessler, Richard Guyer and Hal Matthews in endoscopic laminotomy and discectomy should be recognized. The research and clinical studies of John Regan and Paul McAfee in the field of transthoracic and transperitoneal approaches to spinal disorders and so many others investigators in the field of minimally invasive surgery should also be applauded.