Selective Endoscopic Discectomy™

Abstract

More than 12 yr have passed (1991) since I learned and adopted arthroscopic microdiscectomy (AMD) from pioneer endoscopic spine surgeon Parviz Kambin, who, along with Sadahisa Hijikata, first established the technique for percutaneous nucleotomy in the early 1970s. A cadaver dissection of the traditional posterior anatomy of the lumbar spine compared with the foraminal anatomy clearly illustrates the feasibility and advantages of the foraminal approach to the lumbar disc (Fig.1A,B). Kambin’s AMD technique evolved gradually to allow for more dorsal placement of the cannula to effect posterolateral fragmentectomy and resection of the posterior annulus for stenosis, and it made possible the removal of extruded and sequestered herniated discs (1–4) (Fig. 2). Hijikata (5) also recently reviewed his 12 yr of experience with endoscopic discectomy. In 1996, a new design of the operating spine endoscope adding multichannel irrigation and complementary instrumentation (Fig. 3) (6) allowed further development of endoscopic spine surgery to include the treatment of annular tears causing discogenic back pain (7,8). Advanced techniques of foraminoplasty for central and lateral recess stenosis followed (9–12). The third-generation system design change to the Yeung Endoscopic Spine Surgery (YESS) system gave me more flexibility to maneuver the endoscope and improved ability to probe spinal anatomy in a conscious patient (13). Continued evolution of this technique afforded me the ability to better evaluate the pathological process causing the patient’s discogenic back pain.