Arthroscopic Microdiscectomy
The term arthroscopic microdiscectomy describes an endoscopic surgical technique which can be performed as an intradiscal discectomy or as an extradiscal (transforaminal) procedure. Synonymous terms are percutaneous endoscopic discectomy, percutaneous nuc
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Arthroscopic Microdiscectomy P.KAMBIN
Dandy [7], EIsberg [8], Goldthwaith [9], Putti [52], and Stookey [61], also performed laminectomies for the treatment of low back pain and sciatica in the early The term arthroscopic microdiscectomy describes an twentieth century. endoscopic surgical technique which can be performed Although the early outcome of laminotomy and disas an intradiscal discectomy or as an extradiscal (trans- cectomy is usually satisfactory, the incidence of compliforaminal) procedure. Synonymous terms are percuta- cations [53-60] and interoperative insult to the myolineous endoscopic discectomy, percutaneous nucleo- gamentous structures and facet joints combined with tomywith discoscopic control or transforaminal discec- development of epidural and perineural fibrosis which may lead to segmental instability and chronic neural tomy. edema [46] has led many investigators to introduce an alternative method of intervertebral disc decompres19. 2 Surgical Principle sion without the need of entrance into the spinal canal. Hult [15] in 1956 used the anterior retroperitoneal The key words for arthroscopic or endoscopic disc sur- approach. The concept of chemonucleolysis was introgery are "visualization" and "positioning of instru- duced by Lyman Smith et al. [59] in 1963. In the early ments". The utilization of high resolution glass rod and mid 1970s, mechanical nuclear decompression was fiber-optics allows the clear visualization of neurovas- utilized [12,31]. Automated nucleotomy was introduced cular structures adjacent to the annulatomy site and in the mid 1980s [42,47]. In recent years, various laser determination of adequacy of decompression of the lights have been used for intradiscal nuclear vaporizaneural elements when the surgery is completed. The tion [1,6,21]. The posterolateral approach to the vertebral bodies proper posterior positioning of the instruments and the access cannula provides ample access to the traversing for tissue biopsy was introduced by Valls et al. [62] and and exiting roots, dural sac and minimizes the need for Craig [5] in the late 1940S and mid 1950S. A similar extensive nucleotomy in order to reach the herniation approach was subsequently utilized for discography site. This concept is in contrast with nuclear debulking and nuclear debulking procedures. procedures where the nuclear tissue is mechanically The knowledge of anatomical and arthroscopic resected, [10-12,31,40,47,58] chemically lysed [59] or appearance of the periannular structures [20,22] comvaporized via a laser light [1,4,6,17]. Similar to open bined with radiographic landmark of a safe zone [16,25, discectomy, arthroscopic disc surgery is geared toward 30] on the dorsolateral corner of the annulus have been the resection of herniated disc fragments and decom- instrumental in recent developmental advancement in the field of minimally invasive lumbar surgery via a pression of the nerve roots. posterolateral approach. The knowledge of dimensions of a triangular wor19ยท3 History king zone [16,30,44] has permit
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