Full-Endoscopic Lumbar and Cervical Surgery for Disc Herniation
Lumbar and cervical disc herniations are the most common spine surgery operations, and the future is with minimally invasive techniques.
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Fernando Schmidt and Robert Schoenmayr
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Contents 42.1 42.1.1 42.1.2 42.1.3
42.2 42.2.1 42.2.2 42.2.3
Introduction .............................................. Endoscopic Approaches to the Lumbar and Cervical Spine ..................................... Full-Endoscopic Instruments ..................... Anatomical Considerations for Transforaminal and Interlaminar Full-Endoscopic Lumbar Approach and Cervical Posterior Foraminotomy ....... The Posterolateral and Extreme-Lateral Approach .................................................. Interlaminar Approach ............................... Cervical Posterior Foraminotomy .............. Brazilian Experience with Full-Endoscopic Lumbar Disc Surgery .................................
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Conclusion ..............................................................
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References ...............................................................
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F. Schmidt (*) Neurosurgical Department, Regina Hospital, Av. Mauricio Cardoso, 833 Suite 310, Novo Hamburgo, Brazil e-mail: [email protected] R. Schoenmayr Justus-Liebig-University Giessen, Giessen, Germany Neurosurgical Department, HSK-Kliniken GmbH, Wiesbaden, Germany e-mail: [email protected]
Introduction
The history of the surgery for lumbar disc herniation began about 80 years ago, in fact in 1934, when Mixter and Barr reported the transdural removal of a lumbar disc herniation [4]. To introduce the concept of minimally invasive techniques, since the early 1970s, neurosurgeons have been performing a microsurgical procedure using a microscope to treat lumbar disc herniations through the open interlaminar approach as described by Yasargil and Williams [8, 9]. In using this technique, the surgeon must detach the multifidus muscle from the midline, remove the yellow ligament and some fatty tissues, coagulate vessels, and manipulate the nerve root. Although this technique has been associated with very good results, some patients, about 10 %, can develop scarring of the epidural space and recurrence of the sciatic pain [1]. To overcome the aforementioned complication, also starting from this decade, are the percutaneous discectomy techniques, first only with fluoroscope guidance as described by Hijikata and then with an arthroscope as described by Kambin. At this time, an arthroscope was used only to inspect the annulus and the disc, but the discectomy was done under fluoroscopic guidance. Anthony Yeung developed the first working channel endoscope which allowed constant real-time visualization and discectomy with a uniportal technique [10].
R. Ramina et al. (eds.), Samii’s Essentials in Neurosurgery, DOI 10.1007/978-3-642-54115-5_42, © Springer-Verlag Berlin Heidelberg 2014
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However, the percutaneous endoscopic approach poses challenge to surgeons because of the limited working channel, the type of the disc herniation, and the posterolateral approach that cannot be so close to the epidural space as needed. With the newly developed lateral approach described by R
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