Endoscopic Spine Surgery and Instrumentation


The  combination of high-frequency radiowave disc
ablation, annulus  modulation and manual nucleotomy/decompression in a
single  endoscopic-assisted 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 hands-on experience.
•Meticulous pre-operative surgical planning.
Surgeons  new to the technique should initially work closely with an
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 highlighted the
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
recommend it."
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 author 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
Medicine
'This is a must buy for most neurosurgery and
orthopedic surgery department libraries.  It would also fit very well
into general medical libraries.' -- Doody's Book Review

GET IT HERE