Endoscopic Lumbar Micro-Decompressive Discectomy

Endoscopic Lumbar Micro-Decompressive Discectomy
George Rappard, Ali Maziad, MajlisAasa, James Thacker and John Chiu
Presented at the American Society of Spine Radiology Annual Meeting
Las Vegas, NV. February 19, 2010

Materials and Methods
Retrospective single institution case series
13 consecutive patients underwent endoscopic lumbar disectomy
VAS scores were collected for back and leg pain
11 patients had 1st post-op visit VAS scores
8 patients had at least 2 week follow up VAS scores available
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Patient Inclusion Criteria
Back or leg pain due to lumbar disc herniation
Positive discogram
Failure of conservative management
Post-operative VAS data available
Successful completion of lumbar endoscopic discectomy
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Surgical Technique
All procedures performed under conscious sedation
Patient placed in lateral decubitus position
Transforaminal and/or transpinal approach utilized
Fluroscopic and endoscopic guidance
Mechanical disc decompression performed
Laser thermodiscoplasty performed
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The patient is placed in the lateral decubitus position
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The skin is marked and trajectory determined
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Fluoroscopy is used to determine trajectory
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The tissues along the surgical trajectory are anesthetized
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After K-wire placement a dermotomy is performed
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A series of dilators are advanced over the wire, transforaminaly
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Cannula is advanced over dilator to annulus
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Trephine is advanced through cannula, to perform annulotomy
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Articulating forceps are used for discectomy
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Articulating forceps are used for posterolateral discectomy
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Endoscope is advanced transforaminaly through cannula into canal or into disc
*C
ourtesyMaxmore spine
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Endoscopic discectomy with cutting and grasping forceps
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Intra-cannalicularextradiscal view of herniation
*Courtesy Maxmore spine
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Intra-cannalicularextradiscal view showing decompressed traversing nerve root
*Courtesy Maxmore spine
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Removed osteophytic and disc tissue
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After mechanical discectomy laser cannula is advanced into disc
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After laser thermodiscoplastydiscotome removes debris
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Array of endoscopic discectomy devices
Duckbill retractor, dilator and cannula
Curettes
Graspers
Drills
Cutting forceps
Trephines
Discotomes
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Holmium YAG Laser
2100 nm wavelength
0.5mm ablation zone and 0.5mm coagulation zone
Discoplasty: 40W, 1000J
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Results
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Results
VAS Back
Pre-op: 8.5
Post-op: 4
FU: 4
VAS Leg
Pre-op: 6
Post-op: 1.3
FU: 0
Average FU: 75 days
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Summary
Microdecompressive discectomy is performed via a combination of x-ray and endoscopic guidance
An array of instruments are available to facilitate spinal neural decompression using endoscopic discectomy
Endoscopic discectomy is effective in treating patients with radiculopathy due to HNP
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Endoscopic Lumbar Micro-Decompressive Discectomy

by LABSI on Aug 19, 2010

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Endoscopic Lumbar Micro-Decompressive Discectomy — Presentation Transcript