Endoscopic Spine Surgery and Instrumentation
The combination of high-frequency radiowave disc
ablation, annulus modulation and manual nucleotomy/decompression in a
surgery has more advantages than the single
percutaneous technique, says an expert.
Compared with more invasive procedures, endoscopic spine surgery
reduces the possibility of complications, in particular post-operative
epidural scarring and fibrosis, orthopedic surgeon Dr. Stefan
Hellinger, from Munich, Germany, said at a recent workshop in Petaling Jaya.
As a minimally invasive procedure, it also allows for faster
rehabilitation, return to work and, thus, reduced cost of illness.
"There is minimal surgical trauma [in] this approach as surgery is only
carried out in the region of pathology," said Hellinger. In addition,
it does not require general anesthesia
, can be done on an outpatient
basis and the patient can go home the same day.
Explaining the principles behind endoscopic surgery, Stefan listed the
following requirements for surgeons to effectively perform and
facilitate the procedure, and to avoid unexpected complications:
•Exact knowledge of the surgical procedure.
•Knowledge and understanding of the related anatomy.
•Knowledge of proper patient selection.
•Specific endoscopic spine surgery training.•Previous
•Meticulous pre-operative surgical planning.
Surgeons new to the technique should initially work closely
experienced endoscopic surgeon to negotiate the first steep learning
curve. Besides the usual surgical equipment, including suction and
irrigation, endoscopic spine surgery requires an image converter with
an optional video unit. In this regard, Hellinger highlighte
single-use Disc-FX® System by Elliquence that comes equipped with
access cannulae, guide wires and a controllable radio-frequency probe.
He also noted that the placement of the instruments requires a C-arm fluoroscope.
"The technical performance of the surgery is simple," assured
Hellinger. Using a posterolateral access, a 16- or 18-gauge spinal
needle is introduced transforaminally into the intervertebral disc,
which is then used to place a guide wire. Normally, a 3 mm skin
incision is sufficient for the introduction of the dilatator and
working cannula. Free subligamentary material is removed with the
rongeur, or the annulus is opened with a trepan, and additional disc
material is then removed manually. "Our studies have shown that in this
step, an average of 0.8 g of disc material is removed, with a
corresponding reduction in intradiscal pressure," said Hellinger.
In a 2006/07 prospective controlled study of 66 patients, Hellinger
(and Arnold Feldman) reported significant improvements (recorded by a
visual analog scale) in back and leg pain
at 6 weeks (8.5 to 3.5) and 6
months (3.3) post-operation. In addition, they wrote that "...all
patients would undergo such a surgery again, if necessary, and
To date, the procedure has not yielded major complications, and in
comparison with other minimally invasive procedures of spinal surgery,
the authors assumed the same low risk of less than 1/1000. [The
Internet Journal of Minimally Invasive Spinal Technology 2007;1]
The decision for surgery should mainly be based on a thorough
examination of case history and clinical symptomology. Patients with
symptomatic, contained, lumbar disc herniations that have not responded
to conservative treatment may experience relief from this procedure.
Before deciding on the procedure, all options for conservative therapy,
including epidural injection (the gold standard of intervertebral disc
treatment) should have been exhausted. Also, it is important to note
that endoscopic spine surgery may not be beneficial for advanced
degenerative disc disease or spinal fractures.Review
"A valuable resource for the neurosurgeon or orthopedist
interested in learning more about endoscopic spinal surgery. Each
technique is elucidated by an abundance of clear, colorful images.
Step-by-step illustrations are also included. Considering the breadth
and quality of its contents, the price of $169.95 is reasonable.
Because of the rapid proliferation and growing acceptance of minimal
access spinal technologies, the arrival of this text is timely indeed."
--Journal of Neurosurgery"At last we have a beautifully
illustrated definitive work on endoscopic spinal surgery and
instrumentation. This masterpiece brings together renowned experts in
their fields from all over the world. It not only crosses continents
but also crosses the traditional boundaries between neurosurgeons and
orthopaedic surgeons. Each autho
r instructs the reader in valuable
technical details and gives practical advice on how to maximize patient
benefit. The only rational alternative to buying this book is for the
enthusiastic endoscopic spine surgeon to undertake an expensive and
time-consuming world tour to visit each author in turn. The authors and
publishers are to be congratulated."--The Journal of Orthopaedic
'This is a must buy for most neurosurger
orthopedic surgery department libraries. It would also fit very well
into general medical libraries.
' -- Doody's Book ReviewGET IT HERE