VERTEBRIS Lumbar-Thoracic - Richard Wolf

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<strong>VERTEBRIS</strong> lumbarThe full-endoscopic interlaminar techniqueThe fact that the lighting and imagingsystem with its 25° angle of vision issituated right in the working area makesit possible to minimize traumatizationnot only of the access pathway, butalso of structures of the spinal canal.Continuous irrigation provides excellentvisual conditions. Mobility is achievedby handling of the new endoscope usingthe joystick technique. Neural structuresare protected by use of the beveled operatingsheath as a nerve hook. Whenused in conjunction with the newly developedinstruments, this is a genuinelyminimally invasive technique.more limitations than the interlaminarapproach, but causes less tissue damage.Due to anatomic and pathologicfactors, the ratio of transforaminal tointerlaminar procedures in clinical practiceis about 40 to 60.The main indications are pathologiessituated within the spinal canal. Attentionmust be paid to the width of theinterlaminar window, which if too narrowmay prevent free passage of theendoscope. If this occurs the bone canbe resected with a burr until the targetpoint is reached without opening the ligamentumflavum or damaging thezygapophyseal joints. Bone resectionshould generally be avoided, though incases of spinal canal stenosis it maybe necessitated by the pathology. Theincision in the ligamentum flavum canbe limited to a few millimeters, sincepenetration into the spinal canal is facilitatedby the elasticity of the ligament.Mobility to the contralateral side is similarto that with conventional operations.In order to minimize resection of structuresof the spinal canal, craniocaudalaccess via neighboring lumbar segmentsmay be considered. The full-endoscopicinterlaminar technique permitsselective surgery on pathologies situatedwithin the spinal canal withminimal access-induced traumatization.The transforaminal technique isgenerally more suitable for intradiscaland intra- or extraforaminal work. Thetransforaminal approach is subject toThe interlaminar approach provides outstandingvisualization of the structures of the spinalcanal18
Vertebris1. PositioningThe patient is positioned prone on aradiolucent table with a pelvic and athoracic roll. Use of a C-arm is requiredduring the operation.Prone position with pelvic and thoracic roll2. Determination of access routeAccess is determined on the basis ofanatomic landmarks under posteroanteriorfluoroscopic guidance, accountbeing taken of the pathology. The skinincision should be made as far mediallyin the interlaminar window as possiblein order to permit insertion in alateral direction below the obliquely orientedzygapophyseal joints.Marking of skin entry pointThe skin entry point should be as medial aspossibleEntry below the zygapophyseal joints shouldbe made possiblePuncture incision19
Page 1: VertebrisVERTEBRIS Lumbar-ThoracicF
Page 4 and 5: VERTEBRIS lumbarIntroductionLateral
Page 6 and 7: VERTEBRIS lumbarThe full-endoscopic
Page 20 and 21: VERTEBRIS lumbalThe full-endoscopic
Page 26 and 27: VERTEBRIS thoracic1. The full-endos
Page 28 and 29: VERTEBRISBasic set, VERTEBRIS lumba
Page 30 and 31: VERTEBRISBasic set, VERTEBRIS thora
Page 32 and 33: VERTEBRISSpinal cannula setArticleT
Page 34 and 35: VERTEBRISAccessoriesArticleTypesSma
Page 36 and 37: VERTEBRISForceps / punches, Ø 2.0
Page 38 and 39: VERTEBRISHand-held / accessory inst
Page 40 and 41: LiteratureRUETTEN S, KOMP M, MERK H
Page 42: 42Notes

VERTEBRIS Lumbar-Thoracic - Richard Wolf

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