Benefit of Endoscopic Disc and Spinal Surgery: 7 Years of Neurosurgical Experience
T Lübbers
Citation
T Lübbers. Benefit of Endoscopic Disc and Spinal Surgery: 7 Years of Neurosurgical Experience. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 2.
Abstract
Minimally invasive techniques in spine surgery have progressed rapidly, giving the surgeon endoscopic tools that improve his ability to treat spinal disorders. However microsurgery is still the gold standard in the treatment of lumbar disc herniations. But some disc problems are challenging and the use of a monoportal endoscopic system is beneficial: in a far lateral disc herniation the system is able to decrease duration of the procedure and reduce associated morbidity. We present a series of 15 patients with a far lateral disc herniation in L5/S1. The clinical outcome in 10 patients was good or excellent. One patient was converted into an open procedure. 2 patients were re-operated later and 2 patients suffered from transient dysaesthesia. With the so called in to out maneuver a safe and clear visualization of the exiting nerve root in the dorso-lateral approach is possible. Due to anatomical conditions we can target medio-lateral disc herniations transforaminal in upper lumbar segments without bone removal. Compared to open microsurgery we can avoid extensive bone removal and consecutive instability. In lumbar or thoracic disc infections the system is set up to deliver an antibiotic chain, to remove inflammatory debris, and to irrigate the infected level. To improve stability on the spine with preservation of soft tissue we can additonally use a newly developed technique and system of percutaneous transpedicular screw and plate fixation with regard to lordotic or kyphotic curves. In 10 of 12 cases of a spondylodiscitis we could heal the infection, some with and some without an additional instrumentation. 1 patient died and in one patient an open thoracic debridement with vertebral body replacement was necessary. Needle biopsies of spinal tumors result in 20 % false negative. In 3 tumor cases we could harvest enough material performing a safe diagnosis. 2 isolated cases of a transthoracic monoportal endoscopic and a paravertebral lumbar endoscopic resection of the sympathetic trunk in pain management will be demonstrated. Summary: From a neurosurgical point of view the endoscopic monoportal approach to far lateral disc herniations is probably the best indication for the disorder and in L5/S1 the first choice. A dorso-lateral endoscopic access is helpful in the treatment of a intraspinal disc herniation of the upper lumbar spine and provides a good treatment option of lumbar and thoracic spondylodiscitis before an aggressive dorso-ventral resection and stabilisation should be performed. First results in endoscopic tumor biopsies on the spine and monoportal endoscopic resection of the sympathetic chain seems to be very promising