Posterior Endoscopic Lumbar Discectomy Using a Thoracoport as a Tubular Retractor

Abstract

Objective: To make lumbar discectomy simple and feasible, we developed an endoscopic surgical technique that uses a Thoracoport as a tubular retractor.

Surgical technique: The patient was placed in a 60-degree forwardly inclined lateral position with the side of the lesion on the top. After radiological confirmation of the index level, a Thoracoport was inserted through a 2-cm paramedian transverse skin incision. A 0-degree rod lens endoscope was mounted to a scope holder and placed into the retractor for magnification and illumination. Laminotomy was performed with a high-speed drill to reach the insertion of the yellow ligament to the upper lamina. A 2-mm undercutting of the upper facet was performed with a punch to expose the lateral edge of the nerve root. Surgical instruments were inserted next to the endoscope for manipulation. The herniated disc was identified and removed with pituitary rongeurs as in a standard microdiscectomy. With this technique, a sufficient amount of bone is resected to expose the disc lateral to the nerve root; hemostasis is easily achieved and the incidence of nerve root injury is reduced.

Conclusion: We have successfully performed an endoscopic lumbar discectomy in 20 patients by using a Thoracoport as a tubular retractor. No specially designed instruments were required. This technique was a safe and effective minimally invasive approach to treating lumbar disc disease according to our preliminary experience.

Disc herniation - lumbar spine - Thoracoport - posterior approach

References

• 1 Smith L. Enzyme dissolution of the nucleus pulposus in humans.  JAMA. 1964;  187 137-140
• 2 Maroon J C. Current concepts in minimally invasive discectomy.  Neurosurgery. 2002;  51 (suppl. 2) 137-145
• 3 Hijikata S. Percutaneous nucleotomy: a new concept technique and 12 years experience.  Clin Orthop. 1989;  238 9-23
• 4 Onik G, Mooney V, Maroon J C, Wiltse L, Helms C, Schweigel J, Watkins R, Kahanovitz N, Day A, Morris J. Automated percutaneous discectomy: A prospective multi-institutional study.  Neurosurgery. 1990;  26 228-232
• 5 Choy D S, Case R B, Fielding W, Hughes J, Liebler W, Ascher P. Percutaneous laser nucleolysis of lumbar discs.  N Engl J Med. 1987;  317 771-772
• 6 Schreiber A, Suezawa Y. Transdiscoscopic percutaneous nucleotomy in disc herniation.  Orthop Rev. 1986;  15 35-38
• 7 Mayer H M, Brock M. Percutaneous endoscopic discectomy: Surgical technique and preliminary results compared to microsurgical discectomy.  J Neurosurg. 1993;  78 216-225
• 8 Yeung A T, Tsou P M. Posterolateral endoscopic excision for lumbar disc herniation.  Spine. 2002;  27 722-731
• 9 Foley K T, Smith M M. Microendoscopic discectomy.  Tech Neurosurg. 1997;  3 301-307
• 10 Brayda-Bruno M, Cinnella P. Posterior endoscopic discectomy (and other procedures).  Eur Spine J. 2000;  9 (suppl. 1) S24-S29
• 11 Perez-Cruet M J, Foley K T, Isaacs R E, Rice-Wyllie L, Wellington R, Smith M M, Fessler R G. Microendoscopic lumbar discectomy: technical note.  Neurosurgery. 2002;  51 (suppl. 2) 129-136
• 12 Jho H D. Endoscopic transpedicular thoracic discectomy.  J Neurosurg. 1999;  91 151-156
• 13 Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T. Microendoscopic discectomy (MED) for lumbar disc prolapse.  J Clin Neurosci. 2003;  10 231-235