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DOI: 10.1055/s-2002-34340
An Endoscopic Dural Retractor for Spinal Stenosis Surgery
Publication History
Publication Date:
26 September 2002 (online)
Abstract
Adequate neural decompression is the goal of lumbar stenosis surgery. Often because of limited visualization of the nerve root, significant portions of the facet joints are removed for decompression enhancing the potential for the development of instability. Clearly, the goal to better visualize the anatomy of the lateral recess while decompressing the nerve root may result in better root decompression and a smaller potential for instability secondary to bone loss. In order to accomplish this goal we have designed an endoscopic dural retractor that while retracting the dura permits simultaneous visualization of the anatomy of the lateral recess and the activity of instruments used to decompress it. The endoscopic dural retractor contains a 10,000 pixel endoscope that allows a direct lateral view into the lateral recess while the dura is being retracted. This is a view that cannot be achieved with the operating microscope. One can easily appreciate the anatomy of the lateral recess including the facet joint, ligamentum flavum, lateral dura and nerve root. Ten geriatric cadaver lateral recesses were decompressed endoscopically using the endoscopic retractor. Compression of the nerve root by the facet and ligamentum could easily be identified. One could visually monitor the use of instruments on removal of ligamentum flava and bone compressing the nerve root. In all cases the ligament was easily removed and the facet joint was undercut only enough to decompress the nerve. This instrument has the potential for less invasive decompression of spinal stenosis and further study of its utility is planned.
Key words
Endoscope - Retractor - Spinal Stenosis
References
- 1 Javid M J, Hadar E J. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg. 1998; 89 1-7
- 2 Lee C K, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: Classification, pathologic anatomy and surgical decompression. Spine. 1988; 13 313-320
- 3 Silvers H R, Lewis P J, Asch H L. Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg. 1993; 78 695-701
- 4 Yoshida M, Shima K, Taniguchi Y, Tamaki T, Tanaka T. Hypertrophied ligamentum flavum in lumbar spinal stenosis. Spine. 1992; 17 1353-1360
- 5 Tuite G F, Stern J D, Doran S E. et al . Outcome after laminectomy for lumbar spinal stenosis. Part I: Clinical correlations. J Neurosurg. 1994; 81 707-715
- 6 Tuite G F, Doran S E, Stern J D. et al . Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg. 1994; 81 707-715
- 7 Sanderson P L, Getty C J. Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine. 1996; 21 1352-1356
- 8 Frank E H. Removal of lateral disc herniation using a malleable endoscopic forceps. Neurosurgery. 1998; 41 311-313
- 9 Haines S, Camarata P, Finn M, Poss T. Prototype instruments for endoscopic microsurgery: Technical note. Minimally Invasive Neurosurgery. 1995; 38 167-169
Dr. E. H. Frank
Department of Neurosurgery · Oregon Health Sciences University
3181 SW Sam Jackson Park Road
Portland, Oregon 97201 · USA
Phone: + 1-503-494-4314 ·
Fax: + 1-503-494-7161