VERTEBRIS Lumbar-Thoracic - Richard Wolf

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<strong>VERTEBRIS</strong> lumbarIntroductionLateral approach for the full-endoscopic transforaminaloperationMusculoskeletal pain is one of themost common reasons for visiting thedoctor. Degenerative diseases of thespine form part of daily medical practiceand their treatment is complicatedby medical and socioeconomic problems.Where severe pain or neurologic deficitspersist and all conservative treatmentoptions have been exhausted,surgery may be required. Though conventionaloperations can achieve goodresults, damage may ensue due totraumatization. It is therefore importantthat the surgical techniques usedbe optimized on a continuous basis.The latest research results and technicalinnovations must be critically reviewedso that optimal treatment strategiescan be formulated. The aimshould be to minimize surgically inducedtrauma and negative long-termsequelae, taking existing quality standardsinto account.Minimally invasive techniques can reducetissue damage and its consequences.Endoscopic operations withcontinuous irrigation have advantagesthat have made them the gold standardin a number of areas. Transforaminalprocedures with posterolateralaccess have been performed inthe lumbar spine for more than 20years now, mostly for intradiscal andintra and extraforaminal procedures.In our Department of Spine Surgeryand Pain Therapy we have thereforebeen developing a lateral transforaminaland an interlaminar approach forfull-endoscopic access to the spinalcanal since 1998. These approachesbroaden the range of indications andpermit the use in selected indicationsof a visually controlled procedure thatis as effective as conventional surgerywhile benefiting from all the advantagesof truly minimally invasive surgery.Until fairly recently, the endoscopicapproach was subject to technicalproblems in that the intraendoscopicworking channel of the available opticalsystems was small and the repertoireof instruments that could be usedwas correspondingly limited. Insurmountabledifficulties could arise inthe resection of hard tissue and interms of limited anatomic access andmobility. Work on the affected tissuewas limited and sometimes had to beperformed without direct visualization.New rod lenses with a 4.1 mm intraendoscopicworking channel and correspondingnew instruments, as wellas shavers and burrs, were thereforedeveloped so that full-endoscopicoperations could be performed undercontinuous and precise visual control.This also permitted adequate boneresection. The range of indications forendoscopic spinal surgery was thusbroadened to include intervertebraldisc herniations, spinal canal stenosis,and stabilization techniques.Continuous irrigation provides outstandingintraoperative visualizationThe latest generation of endoscopes have alarge (4.1 mm) working channel4
VertebrisFull-endoscopic surgery has now wona firm place in the surgery of lumbarspine conditions. Provided that the indicationsfor its use are observed, it representsa useful and safe addition oralternative to conventional surgery. Fullendoscopicoperations can also be performedon the cervical and thoracic spine.Recent technical developments andthe use of new access routes have ledling the end of existing operative standards;rather, it should be seen as avaluable additional option within thefield of spinal surgery.Herne, July 2007Dr. Sebastian Ruetten, M.D.Head Department of Spine Surgery andPain TherapyThe development of new instruments broadensthe range of possible proceduresto a change that suggests the onset ofa revolution in spinal surgery similar tothat which occurred in orthopedics withthe introduction of arthroscopic procedures.Nevertheless, conventional andmaximally invasive operations will continueto play an indispensable role inspinal surgery. Surgeons will need to beable to perform these techniques too inorder to overcome problems and complicationsof full-endoscopic operationssuch as can occur with any invasiveprocedure.The development of full-endoscopictechniques should not be seen as spel-Department of Spine Surgery and Pain TherapyHead: Dr. Sebastian Ruetten, M.D.Center for Orthopaedics and TraumatologySt. Anna Hospital, Herne, GermanyDirector: Prof. Georgios Godolias, M.D.at the Department of Radiology and MicrotherapyUniversity of Witten/Herdecke5
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VERTEBRIS Lumbar-Thoracic - Richard Wolf

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