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DOI: 10.1055/s-2002-34345
Technique of Microendoscopy in Medial Lumbar Disc Herniation
Publication History
Publication Date:
26 September 2002 (online)
Abstract
Various percutaneous techniques to approach the lumbar disc were studied in the past. Chemonucleolysis, laser vaporization, lateral endoscopic foraminal approaches and different techniques of percutaneous nucleotomy remained disappointing due to insufficient root visualization, insufficient decompression or insufficient disc removal. The microendoscopic discectomy is performed via a median approach that allows thorough root exploration, direct evaluation of the compression and determination of contained or non-contained disc material. This is achieved by applying open surgical tools through a tubular retractor under endoscopic visualization. The endoscope is inserted via a sequential set of dilators passed over the initial guide wire. The technique allows a smaller incision and less tissue trauma with comparable visualization of the nerve structures than does standard open surgery.
Key words
Microendoscopic Discectomy - Technical Adjuncts - Lumbar Disc Herniation
References
- 1 Smith L. Enzyme dissolution of the nucleus pulposus in humans. JAMA. 1964; 265 137-140
- 2 Hijikata S. Percutaneous nucleotomy: A new concept technique and 12 years' experience. Clin Orthop. 1989; 238 9-23
- 3 Choy D SJ, Case R B, Fielding W. Percutaneous laser nucleolysis of lumbar discs. N Engl J Med. 1987; 317 771-772
- 4 Gottlob C, Kopchok G E, Peng S K. Laser ablation of human intervertebral disc: Preliminary evaluation. Lasers Surg Med. 1992; 12 86-91
- 5 Knight M TN, Vajda A, Jakab G V, Awan S. Endoscopic laser foraminoplasty on the lumbar spine - early experience. Minim Invas Neurosurg. 1998; 41 5-9
- 6 Kambin P. Diagnostic and therapeutic spinal arthroscopy. Neurosurg Clin N Am. 1996; 7 65-76
- 7 Kambin P, Schaffer J L. Percutaneous nucleotomy: Review of 100 patients and current practice. Clin Orthop. 1989; 128 24-34
- 8 Savitz M H. Same-day microsurgical arthroscopic lateral-approach laser-assisted (SMALL) fluoroscopic discectomy. J Neurosurg. 1994; 80 1039-1045
- 9 Schreiber A, Suezawa Y. Transdiscoscopic percutaneous nucleotomy in disc herniation. Orthop Rev. 1986; 15 35-38
- 10 Friedman W A. Percutaneous discectomy: An alternative to chemonucleolysis. Neurosurgery. 1983; 13 542-547
- 11 Mayer H M, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg. 1993; 78 216-225
- 12 Schaffer J L, Kambin P. Percutaneous posterolateral lumbar discectomy and decompression with a 6.9 mm cannula: Analysis of operative failures and complications. J Bone Joint Surg. 1991; 73 822-831
- 13 Onik G, Mooney V, Maroon J C. Automated percutaneous discectomy: a prospective multi-institutional study. Neurosurgery. 1990; 26 228-233
- 14 Dirksmeier P J, Parsons I M, Kang J D. Microendoscopic and open laminotomy and discectomy in lumbar disc disease. Seminars in Spine Surgery. 1999; 11 138-146
- 15 Ditsworth D A. Endoscopic transforaminal lumbar discectomy and reconfiguration: a posterior approach into the spinal canal. Surg Neurol. 1998; 49 588-597
- 16 Kahanovitz N, Viola K, Goldstein T, Dawson E. A multicenter analysis of percutaneous discectomy. Spine. 1990; 15 713-715
- 17 Leu H, Schreiber A. Endoskopie der Wirbelsäule: minimal-invasive Therapie. Orthopäde. 1992; 21 267-272
- 18 Mochida J, Arima T. Percutaneous nucleotomy in lumbar disc herniation. A prospective study. Spine. 1993; 18 2063-2068
- 19 Ogon M, Maurer H, Wimmer C, Landauer F, Sterzinger W, Krismer M. Minimal-invasive Zugänge und Operationsverfahren an der Lendenwirbelsäule. Orthopäde. 1997; 26 553-561
- 20 Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Research. 1999; 21 39-42
- 21 Foley K T, Smith M M. Microendoscopic discectomy. Techniques in Neurosurgery. 1997; 4 301-307
U. Schick, M. D.
Clinic of Neurological Surgery · University of Leipzig
Johannisallee 34
04103 Leipzig ·Germany
Phone: +49-341-97-12000
Fax: +49-341-97-12009
Email: Uta_Schick@web.de