Endoscopic Spine Surgery

1. ENDOSCOPIC LUMBAR DISCECTOMY

When disc fragments are ruptured and herniated into the spinal canal, a paramedian posterior approach is recommended. Through a 10- or 15-mm trocar via a 1.5- or 2-cm skin incision, ruptured disc fragments are excised under direct endoscopic visualization. The remaining disc between the vertebral bodies is preserved as much as possible in order to minimize postoperative back pain. Surgery can be performed under local or general anesthesia. Compared to conventional microscopic discectomy, endoscopic surgery is carried out with a smaller incision, less tissue dissection, and less bone removal.

Advantages of Endoscopic Discectomy

§ The procedure for Lumbar Disc Herniation is accomplished through a skin incision approximately 1.5 to 2 cm in length.

§ Although it can be performed under local anesthesia, it has usually been performed under general anesthesia.

§ Operation time takes approximately one hour or less.

§ It utilizes an endoscope for enhanced visualization, and the operation is performed under the guidance of monitored endoscopic images.

§ Patients can often be discharged the day of surgery or the morning after surgery.

§ Patients are usually fully ambulatory immediately after surgery.

§ Patients are often able to return to work in 2 to 3 weeks.

§ It is minimally invasive surgery because the surgical incision is small, surgical dissection is minimal, bone removal is minimal, and disc removal is limited to the ruptured portion of the disc.

§ It still achieves the goal of surgery that the classic conventional lumbar discectomy accomplishes.

2. ENDOSCOPIC DECOMPRESSION FOR LUMBAR SPINAL

STENOSIS

A 1.5 cm trocar is placed via a 2-cm skin incision at the lumbar area. A small foraminotomy hole is made at a stenotic segment of the lumbar spine. Through this small foraminotomy hole, the stenotic spinal canal is enlarged bilaterally. The operation can be performed at multiple levels. This anatomy-preserving surgery minimizes surgical impact to the spine. Unlike conventional laminectomy surgery, the spinal integrity (including the anatomy and function) is preserved with this endoscopic surgery. This functional lumbar stenosis surgery does not require bone fusion or metal plate implantation. Thus, surgical recovery is fast. In particular, the minimally invasiveness of this surgery enables elderly patients to ambulate soon after surgery.

Advantages of Endoscopic Decompression for Lumbar Spinal Stenosis

§ It minimizes bone resection, maintaining spinal integrity while widening the lumbar spinal canal.

§ It is less invasive because spinal decompression is accomplished with a small incision, minimal tissue dissection, and minimal bone removal when compared with conventional laminectomy techniques.

§ The procedure is innovative because it accomplishes effective widening of the narrowed spinal canal without weakening the spine.

§ It can be done on multiple levels if necessary.

§ The procedure avoids bone fusion or the use of metal implants and allows the patient to be more mobile immediately after surgery.

§ It is often done on an overnight stay basis.