Advertisement

Posterior Endoscopic Discectomy Using as Endoscopic Lumbar Discectomy System Developed in Japan

  • Yutaka Hiraizumi
Conference paper

Summary

The characteristics of the endoscopic lumbar discectomy system (ELDS) developed in Japan are introduced, and the first 50 cases are clinically evaluated. The patients included four cases of double disc herniation at two levels, one of cranially and three of caudally migrated discs, three of spinal canal stenosis, one of synovial cyst, and three of persistent ring apophysis. In four central disc herniation cases, one case was approached bilaterally and the other three cases unilaterally. Using a step-dilator system, the targeting interlaminar space was exposed and a tubular retractor of either 16 or 18 mm diameter was inserted through the paravertebral muscle. A 30° endoscope of 3-mm diameter was installed into a tubular retractor. Partial laminectomy and resection of the ligamentum flavum were performed using microsurgical instruments, followed by medial retraction of the symptomatic nerve root and incision of the herniated disc. The average surgery time was 119 min, and the average estimated blood loss was 49.1g. The patients left their beds at an average of 1.9 days postoperatively, and the average hospital stay was 11.5 days. The recovery ratio of the Japanese Orthopaedic Association (JOA) score was 80.7%. The average visual analogue pain score on the first postoperative day was 2.9cm, and the C-reactive protein level on the 7th day was 0.4 mg/dl. Adjacent two-level discectomy was possible with one midline skin incision. Coexistence of severe lumbar spinal canal stenosis was the most technically demanding pathology. The ELDS provided a brightened and magnified surgery field. This can be an effective assistant for minimally invasive lumbar disc surgery.

Key words

Endoscopic discectomy Lumbar spine Disc herniation Microendoscopy Endoscopic surgery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Landreneau RJ, Mack MJ (1992) Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies. Ann Thorac Surg 54:800–807PubMedGoogle Scholar
  2. 2.
    Hiraizumi Y, Jin Y, Hoshida T, et al (1999) Minimallly invasive spine surgery by endoscopic technique. J Jpn Orthop Assoc 73:605Google Scholar
  3. 3.
    Hiraizumi Y, Jin Y, Hoshino Y, et al (2000) New medical technology: endoscopic discectomy (herniotomy) for spinal disc herniation. Orthop Surg Traumatol 43:837–844Google Scholar
  4. 4.
    Foley KT, Smith MM (1997) Microendoscopic discectomy. Techn Neurosurg 3:301–307Google Scholar
  5. 5.
    Fujimaki Y, Hiraiuzmi Y, Jin Y, et al (1998) Endoscopic posterior approach for herniated nucleus pulposus of the lumbar spine. J Jpn Spine Res Soc 9:306Google Scholar
  6. 6.
    Hiraizumi Y, Fujimaki E, Kimura Y (1996) Surgical technique and results of Caspar’s procedure in lumbar disc herniotomy. Bessatu-seikeigeka 30:192–198Google Scholar
  7. 7.
    Dvorak J, Gauchat MH, Valach L (1988) The outcome of surgery for lumbar disc herniation. Spine 13:1418–1422PubMedGoogle Scholar
  8. 8.
    Caspar W (1977) A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4:74–77Google Scholar
  9. 9.
    Mikumo H, Hiraizumi Y, Taki S, et al (1999) Over 5 years follow-up results of Caspar’ procedure (microscopic discectomy) for lumbar disc herniation. J Eastern Jpn Assoc Orthop Traumatol 11:421Google Scholar
  10. 10.
    Kehlet H (1997) Multimodal approach to control post-operative pathophysiology and rehabilitation. Br J Anaesth 78:606–617PubMedGoogle Scholar
  11. 11.
    Hiraizumi Y (2000) Microscopic resection of lumbar lateral disc herniation. J Minim Invas Orthop Surg 19:54–59Google Scholar
  12. 12.
    Hiraizumi Y (2000) Minimally invasive spine surgery: endoscopic posterior approach for lumbar disc herniation. New OS NOW 7:44–52Google Scholar
  13. 13.
    MaCulloch JA (1996) Focus issue on lumbar disc herniation: macro-and microdiscectomy. Spine 21:45S–56SGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Yutaka Hiraizumi
    • 1
  1. 1.Department of Orthopaedic SurgeryShowa University School of MedicineTokyoJapan

Personalised recommendations