Spinal Endoscopy: Historical Review and Current Applications
This chapter gives background on the origins of spinal endoscopy and elaborates on the precise use of terms that are commonly used in the context of spinal endoscopic procedures.
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Spinal Endoscopy: Historical Review and Current Applications C. Birkenmaier
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Nomenclature and Terminology
The term “endoscopy” implies the use of a thin, tubular and coaxial surgical instrument that contains image transmission, illumination, and frequently also irrigation and a working channel. Such an instrument is placed into the surgical field via a small stab incision and by means of tissue dilation. The image is produced by a camera at the end of the optical system and transmitted to a monitor. In the spine and different to endoscopy of preformed body cavities, the very limited surgical space is constantly irrigated to maintain visibility, to control bleeding, to cool tissue when radiofrequency or laser are being used, and to wash out surgical debris. These specific features distinguish “true” endoscopy (or “full endoscopy” as termed by Ruetten) from tubular microendoscopy, where a small retractor or working tube is placed and surgery is performed “in the dry” and with standard microsurgical instruments under camera vision. Examples for the latter technique could be the Storz “Destandau” system or the more recently developed Storz “Easy-Go system.”
C. Birkenmaier (*) Department of Orthopedics, Physical Medicine and Rehabilitation—University of Munich (LMU), Munich, Germany e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2020 J.-S. Kim et al. (eds.), Endoscopic Procedures on the Spine, https://doi.org/10.1007/978-981-10-3905-8_1
Another synonym for “full endoscopy” that is commonly used in the Asian literature is “working channel endoscopy,” which stresses the fact that such modern coaxial endoscopes contain an instrument channel beyond the rod lens, the illumination, and the irrigation channel. Frequently used technical descriptions in the context of endoscopy are “percutaneous” or “minimally invasive.” However, these terms are not truly meaningful since all surgery (apart from superficial dermatological surgery) is in principle percutaneous and since no generally accepted definition of “minimal invasiveness” exists. Provided that the term “endoscopic” is used precisely and appropriately, no further qualifying adjectives should be required to explain the nature of the surgical approach and the type of surgical endoscope used. Another conceptual problem tends to be the implied but not spelled-out inclusion of one specific anatomic approach into the name of a surgical technique. A very good example would be the acronym PELD for “percutaneous endoscopic lumbar discectomy.” PELD typically implies that the traditional transforaminal approach is used. However, many pathologies that can be treated by means of “transforaminal” PELD can equally or sometimes even better be addressed using an interlaminar or in certain cases a transosseous (burr hole) approach. This terminological imprecision tends to be further complicated by the indiscriminate use of 1
C. Birkenmaier
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the term “discectomy,” which is not what microscopic or endoscopic spine surgeons perform these days. Probably t
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