Endoscopic spinal decompressive techniques are rapidly enhancing the minimally invasive care of spinal disorders. The development of full endoscopic surgical tools coupled with enhanced optical visualization and navigation are synergistically advancing endoscopic techniques and indications. Complex spinal pathologies such as extra-foraminal disc herniation, discitis, multifocal disc herniation, and recurrent disc herniations can be endoscopically approached with a significant decrease in morbidity. Endoscopic direct spinal decompression and disc space preparation for spinal fusion done can be performed under regional/local anesthesia thereby enhancing “ultra” minimally invasive surgery and enhanced recovery after surgery principles.
A number of elements are required to result in successful endoscopic decompressive spine surgery. These elements include (1) careful physical examination, (2) a comprehensive knowledge and evaluation of all pertinent radiographic studies, (3) appropriate diagnostic injection testing and interpretation, and (4) phasic surgical training. Surgical training includes didactic, cadaveric, and direct live surgery observation. Unlike traditional open surgery, endoscopic training is phasic with repetitive didactic, cadaveric, and observational training before and after embarking on decompressive surgery, before and after transforaminal decompressive and fusion surgery, and before and after direct posterior and interlaminar decompressive techniques. Appropriate initial needle placement permits targeted decompression for varying disc pathology locations and indications. Lastly, anesthetic considerations are also a critical component of a successful endoscopic spinal surgery. The surgeon and anesthesia team should be comfortable performing surgery utilizing regional/local as well as general anesthesia techniques. Adhering to the above, tenets will help mitigate complications.
Endoscopic surgery Targeted needle placement Interlaminar decompression Transforaminal approaches Foraminoplasty
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