Multi-level spine endoscopy

Abstract

In the last ten years, there has been an exponential increase in endoscopic spinal surgery practice.With improvements in equipment quality and the availability of high definition camera systems, cervical endoscopic disc resection is now a viable alternative to anterior cervical decompression and fusion (ACDF) or disc arthroplasty for the treatment of disc prolapse and low grade stenosis.Based on the current literature, there is now strong evidence to support the use of transforaminal endoscopic approaches for the treatment of thoracic disc prolapse.There is now level I evidence to show that outcomes following transforaminal endoscopic discectomy (TED) are at least equivalent to those after open microdiscectomy, with an expected shorter operating time, lesser requirement for analgesia, reduced duration of post-operative disability, more rapid rehabilitation and lower costs of care. However, it should be recognised that there is a significant learning curve for TED.New endoscopic techniques with interlaminar approaches allow the decompression of central and lateral recess stenosis. Future developments will facilitate vision and access to the spine with 3D imaging and robotics at the forefront.We present a case report of whole spine endoscopic decompression to illustrate the potential of endoscopic surgery at all spinal levels.Cite this article: EFORT Open Rev 2017;2:317-323. DOI: 10.1302/2058-5241.2.160087

Clinical outcomes of MED and iLESSYS^® Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

“…The iLESSYS ® Delta set contains specially designed instruments to enable a comprehensive decompression of the spinal canal and the size of the working cannula and endoscopic instruments are larger compared with those used in the traditional endoscope system ( 8 , 16 , 17 ). The 10-mm outer diameter endoscope and 6-mm working cannula used in the iLESSYS ® Delta system have been found to provide a broader endoscopic field of view, permitting the use of a larger burr for the resection of osteophytes and more powerful grasper forceps to remove the residual fragments ( 17 ). By taking advantage of these advantages, ULBD can be performed under endoscopy using the iLESSYS ® Delta system to treat LCSS and LRS.…”

“…Therefore, the Interlaminar Endoscopic Surgical System (iLESSYS ® ) Delta system (Joimax ® GmbH) has been subsequently developed from the traditional PELD system for the treatment of LSS. The iLESSYS ® Delta system is equipped with a larger size working cannula and endoscopic instruments, which permits big osteophytes or soft tissues to be removed without extra maneuvers under good endoscopic visualization ( 8 , 16 , 17 ). This design has made the treatment of LCSS and LRS more efficient through using the interlaminar approach ( 8 , 16 , 17 ).…”

“…The iLESSYS ® Delta system is equipped with a larger size working cannula and endoscopic instruments, which permits big osteophytes or soft tissues to be removed without extra maneuvers under good endoscopic visualization ( 8 , 16 , 17 ). This design has made the treatment of LCSS and LRS more efficient through using the interlaminar approach ( 8 , 16 , 17 ). Therefore, the present study aimed to retrospectively compare the radiographic and clinical outcomes of LCSS and LRS treated with both the MED and iLESSYS ® Delta approaches.…”

Endoscopic Spine Surgery: Current State of Art and the Future Perspective

“…Endoscopic surgery encompasses the benefits of ‘traditional’ minimally invasive surgery. Most of these surgeries can be performed under local anesthesia with sedation in an outpatient setting, with some studies reporting improved quality of life [ 3 5 6 ] and potential for reduced costs [ 7 ]. However, more literature is needed to further investigate these potential benefits over traditional open procedures.…”

“…However, the use of endoscopy has been slow to develop, partly due to un-familiarity with the technique and clinical benefits. Studies of its safety and efficacy are beginning to surface [ 3 4 5 ], and full endoscopic spine procedures are now being performed in spine centers around the world.…”