Results of New Endoscopic Instrument Used for Disc Removal
Over the last 30 years, instruments to allow surgeons to see inside the spine without open incisions have improved remarkably. The tool used is called an endoscope. There is a tiny TV camera on the end that allows the surgeon to look on a video screen and see inside the spinal canal.
A small cut is made in the skin and the endoscope inserted into the spine. Surgical instruments are passed down through the endoscope. The tool can be inserted through the back of the spine. This is called an interlaminar approach. Or it can be passed through the side of the vertebral bone called a transforaminal approach.
The approach used depends on where the disc material is located. If it's inside the spinal canal, then the translaminar method is used. If the disc is near or around the spinal nerve, then the interlaminar approach is best.
In this study, the results of disc removal using a new endoscope are reported. The new tool was designed to help reduce problems with tissue trauma and access to the disc in such small places.
It has a larger working channel so larger tools can be used. More bone can be shaved away giving the surgeon a bigger working space. The new endoscope also gives the surgeon a wider view of the tissues, bone, and disc material.
The authors describe in detail the operative technique used with both approaches. The advantage of the full endoscopic operation is easier removal of all the disc tissue without causing trauma. It is a minimally invasive operation with less scarring. And with the transforaminal approach, the ligamentum flavum, a supporting ligamentous structure in the spine isn't cut.
Patient results after full-endoscopic surgery weren't any better than with conventional operations. The difference was that the surgeon had a better view of the operative field and fewer technical problems to deal with.
The authors conclude full-endoscopic techniques won't replace current methods used. They will have their own place with certain patients. There is a shorter operating time, less tissue trauma, and less bleeding with this new tool. The result is quicker rehab and lower costs for some patients.
Sebastian Ruetten, MD, PhD, et al. Use of Newly Developed Instruments and Endoscopes: Full-Endoscopic Resection of Lumbar Disc Herniations Via the Interlaminar and Lateral Transforaminal Approach. In Journal of Neurosurgery: Spine. June 2007. Vol. 6. No. 6. Pp. 521-530.