Minimally invasive techniques in spinal surgery: current practice

Kambin, Parviz; Gennarelli, Thomas A.; Hermantin, Frank U.

doi:10.3171/foc.1998.4.2.11

Cited by 27 publications

(14 citation statements)

References 23 publications

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“…Transforaminal endoscopic lumbar discectomy may be used for upper lumbar disc herniations [17]. A radiological analysis of the upper lumbar region before the operation may be useful to perform a safer procedure.…”

Section: Discussionmentioning

confidence: 99%

Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

et al. 2012

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Study DesignClinical study.PurposeThe dimensions of the working zone for endoscopic lumbar discectomy should be evaluated by preoperative magnetic resonance images. The aim of this study was to analyze the angle of the roots, root area, and foraminal area.Overview of LiteratureFew studies have reported on the triangular working zone during transforaminal endoscopic lumbar discectomy. Many risk factors and restrictions for this procedure have been proposed.MethodsImages of 39 patients were analyzed bilaterally at the levels of L3-L4 and L4-L5. Bilateral axial and coronal angles of the roots, root area, and foraminal area were calculated.ResultsNo significant difference was observed between the axial angle of the left and right L3 root. A significant difference was found between the axial angle of right and left L4 roots. A significant difference was observed when the coronal angle of the right and left L3 roots were compared, but no significant difference was found when the coronal angle of the right and left L4 roots were compared. No significant difference was observed when the foraminal area of the right and left L3 and L4 roots were compared, but a significant difference was observed when the root area of right and left L3 and L4 roots were compared.ConclusionsWe suggest that these radiological measurements should be obtained for safety reasons before endoscopic discectomy surgery.

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Section: Discussionmentioning

confidence: 99%

Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

et al. 2012

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“…The use of small-calibre endoscopes through this space allowed the peri-annular and neural structures to be seen and herniated disc fragments to be removed under direct vision. 11,12 When the conventional posterolateral approach was used, the approach angle was 45°. As transforaminal techniques developed, the approach angle moved closer to the horizontal plane: from 35° to 45° from the horizontal as described by Kambin et al, 6 to 25° to 30° by Yeung and Tsou, 7 and 20° to 25° by Yeung and Yeung.…”

Section: Discussionmentioning

confidence: 99%

CT scan assessment of the pathway of the true lateral approach for transforaminal endoscopic lumbar discectomy

Lee

Kim

Park

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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We performed a prospective study to examine the influence of the patient's position on the location of the abdominal organs, to investigate the possibility of a true lateral approach for transforaminal endoscopic lumbar discectomy. Pre-operative abdominal CT scans were taken in 20 patients who underwent endoscopic lumbar discectomy. Axial images in parallel planes of each intervertebral disc from L1 to L5 were achieved in both supine and prone positions. The most horizontal approach angles possible to avoid injury to the abdominal organs were measured. The results demonstrated that the safe approach angles were significantly less (i.e., more horizontal) in the prone than in the supine position. Obstacles to a more lateral approach were mainly the liver, the spleen and the kidneys at L1/2 (39 of 40, 97.5%) and L2/3 (28 of 40, 70.0%), and the intestines at L3/4 (33 of 40, 82.5%) and L4/5 (30 of 30, 100%). A true lateral approach from each side was possible for 30 of the 40 discs at L3/4 (75%) and 23 of the 30 discs at L4/5 (76.7%). We concluded that a more horizontal approach for transforaminal endoscopic lumbar discectomy is possible in the prone position but not in the supine. Prone abdominal CT is more helpful in determining the trajectory of the endoscope. While a true lateral approach is feasible in many patients, our study shows it is not universally applicable.

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“…Исторически первым был предложен заднебо-ковой доступ, когда рабочая канюля вводилась непосредственно в полость МпД и производи-лось удаление массы пульпозного ядра [15][16][17]. предпосылкой к развитию интерламинарной эндоскопической дискэктомии стало наличие технических трудностей при заднебоковом до-ступе к промежутку LV-SI у мужчин с высоким стоянием гребня подвздошных костей и наи-меньшим размером межпозвонковых отверстий [4,18,19].…”

Section: критерии соответствияunclassified

Outcomes of Transforaminal Endoscopic Discectomy for Lumbosacral Disc Herniation

Волков

Карабаев

Пташников

et al. 2017

Traumatology and Orthopedics of Russia

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Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in comparison with microdiscectomy (MD) and to specify factors determining complications and failures.Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9%) which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic procedure are associated with technique drawbacks as well as with mistakes in planning and performing the approach. Congenital alignment of lumbar spine with specific patterns of facets and foramina anatomy dictate technical difficulties with transforaminal approach.

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Minimally invasive techniques in spinal surgery: current practice

Cited by 27 publications

References 23 publications

Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

CT scan assessment of the pathway of the true lateral approach for transforaminal endoscopic lumbar discectomy

Outcomes of Transforaminal Endoscopic Discectomy for Lumbosacral Disc Herniation

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