Percutaneous endoscopic spinal surgery for degenerative disc disease 1989-2009 : From pioneering applications to proven standards
A Fontanella. Percutaneous endoscopic spinal surgery for degenerative disc disease 1989-2009 : From pioneering applications to proven standards. The Internet Journal of Minimally Invasive Spinal Technology. 2008 Volume 3 Number 4.
The present spinal surgery requires, more than ever, that the greatest possible therapeutic result should be achieved with the least amount of iatrogenic effects. The stereotaxy was the first step towards minimally invasive technique. Subsequently, the introduction of the operating microscope permitted a reduction of surgical field with consequent improvement of surgical procedure. Furthermore, the development of neuro imaging methods, like CT and MRI, revolutionised radiologic diagnostics, permitting precise surgical planning and three-dimensional programming. The use of the computer applied to the surgery, the so called “navigator” has yielded high precision in surgical techniques. The endoscopes, optic flexible or rigid instruments transferring images from an area inside the body to the outside by microcamera system, allowed the development of spinal endoscopic microsurgery. Following this philosophy, keyhole surgery began, to the patient’s benefit. Our personal experience in the minimally invasive spinal surgery started from 1989 and up to date we performed 5962 operations on the spine by using this technique. We treated disc herniation, spinal stenosis, spinal instability, traumatic injuries, some benign tumor, and complications of previous surgery, such as epidural fibrosis, vertebral instability and others. In cervical spine we used anterior approach, sometimes posterior approach and, when required, transoral approach. In thoracic spine we used parapedicular-transforaminal approach, thoracoscopic anterior and anterolateral approach, when required, posterior approach. In lumbar spine we used posterolateral-transforaminal approach, posterior approach, laparoscopic retroperitoneal and transperitoneal approach, in a few cases inferior approach and, when required, posterolateral transdiscal approach. This experience suggests that the endoscopic microsurgical technique on the spine is an extremely advantageous and safe method. We think that the development and improvement of instruments, longer follow-up periods and a greater number of patients treated, will further confirm this minimally invasive spinal surgery, to the patient’s advantage