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Minimally Invasive Percutaneous Endoscopic Discectomy: Transdiscal Approach

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Advanced Procedures for Pain Management

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Abstract

Since Kambin performed the first endoscopic discectomy in 1983 [1], various minimally invasive surgical techniques have been developed to mitigate the deleterious effects of disc herniation and nerve root compression. The current minimally invasive discectomy approaches are interlaminar, transforaminal, and transdiscal. Regardless of the approach, the goal is the resection of a herniated disc under direct endoscopic visualization. Compared with open discectomy, minimally invasive methods have been shown to eliminate cutting of muscles, reduce the rate of infection, shorten operating time, minimize blood loss, and decrease the incidence of cerebral spinal fluid leak and other major complications [2–5]. Although the routine use of endoscopic discectomy for the lumbar and cervical spine remains controversial [6–13], future high-quality research will help to delineate optimal treatment algorithms. This chapter presents the current concepts of the most commonly performed endoscopic spinal surgery [14–17]—the transdiscal approach. Relevant spinal anatomy, patient selection, clinical considerations, and the detailed surgical techniques are discussed.

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References

  1. Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine: a preliminary report. Clin Orthop Relat Res. 1983;174:127.

    Google Scholar 

  2. Ohya J, Oshima Y, Chikuda H, Oichi T, Matsui H, Fushimi K, et al. Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score-matched analysis using a nationwide administrative database. Neurosurg Focus. 2016;40:E5.

    Article  PubMed  Google Scholar 

  3. Wong AP, Shih P, Smith TR, Slimack NP, Dahdaleh NS, Aoun SG, et al. Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. World Neurosurg. 2014;81:634–40.

    Article  PubMed  Google Scholar 

  4. Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP. Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the “classic” open approach. Minim Invasive Neurosurg. 2008;51:100–5.

    Article  CAS  PubMed  Google Scholar 

  5. O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11:471–6.

    Article  PubMed  Google Scholar 

  6. Evaniew N, Khan M, Drew B, Kwok D, Bhandari M, Ghert M. Minimally invasive versus open surgery for cervical and lumbar discectomy: a systematic review and meta-analysis. CMAJ Open. 2014;2:E295–305.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lubelski D, Mihalovich KE, Skelly AC, Fehlings MG, Harrop JS, Mummaneni PV, et al. Is minimal access spine surgery more cost-effective than conventional spine surgery? Spine (Phila Pa 1976). 2014;39:S65–74.

    Article  Google Scholar 

  8. Mu X, Wei J, Li P. What were the advantages of microendoscopic discectomy for lumbar disc herniation comparing with open discectomy: a meta-analysis? Int J Clin Exp Med. 2015;8:17498–506.

    PubMed  PubMed Central  Google Scholar 

  9. Gibson JN, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: the future ‘gold standard’ for discectomy?—a review. Surgeon. 2012;10:290–6.

    Article  PubMed  Google Scholar 

  10. Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A. Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: a meta-analysis. Int J Surg. 2016;31:86–92.

    Article  PubMed  Google Scholar 

  11. Anichini G, Landi A, Caporlingua F, Beer-Furlan A, Brogna C, Delfini R, Passacantilli E. Lumbar endoscopic microdiscectomy: where are we now? An updated literature review focused on clinical outcome, complications, and rate of recurrence. Biomed Res Int. 2015;2015:417801.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ahn SS, Kim SH, Kim DW, Lee BH. Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults: a retrospective matched cohort study. World Neurosurg. 2016;86:250–8.

    Article  PubMed  Google Scholar 

  13. Dohrmann GJ, Mansour N. Long-term results of various operations for lumbar disc herniation: analysis of over 39,000 patients. Med Princ Pract. 2015;24:285–90.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tsou PM, Alan Yeung C, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J. 2004;4:564–73.

    Article  PubMed  Google Scholar 

  15. Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6:521–30.

    Article  PubMed  Google Scholar 

  16. Lühmann D, Burkhardt-Hammer T, Borowski C, Raspe H. Minimally invasive surgical procedures for the treatment of lumbar disc herniation. GMS Health Technol Assess. 2005;1:Doc07.

    PubMed  PubMed Central  Google Scholar 

  17. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976). 2002;27:722–31.

    Article  Google Scholar 

  18. Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat. 1981;132:39–56.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Alkhatib B, Rosenzweig DH, Krock E, Roughley PJ, Beckman L, Steffen T, et al. Acute mechanical injury of the human intervertebral disc: link to degeneration and pain. Eur Cell Mater. 2014;28:98–110; discussion 110–1.

    Article  CAS  PubMed  Google Scholar 

  20. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14:2525–45.

    Article  PubMed  Google Scholar 

  21. Hussein M, Abdeldayem A, Mattar MM. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. Eur Spine J. 2014;23:1992–9.

    Article  PubMed  Google Scholar 

  22. Gore S, Yeung A. The “inside out” transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. Int J Spine Surg. 2014;8. https://doi.org/10.14444/1028.

    Google Scholar 

  23. Lewandrowski KU. “Outside-in” technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg. 2014;8. https://doi.org/10.14444/1026.

    Google Scholar 

  24. Singh V, Piryani C, Liao K. Role of percutaneous disc decompression using coblation in managing chronic discogenic low back pain: a prospective, observational study. Pain Physician. 2004;7:419–25.

    PubMed  Google Scholar 

  25. Alò KM, Wright RE, Sutcliffe J, Brandt SA. Percutaneous lumbar discectomy: clinical response in an initial cohort of fifty consecutive patients with chronic radicular pain. Pain Pract. 2004;4:19–29.

    Article  PubMed  Google Scholar 

  26. Manchikanti L, Singh V, Calodney AK, Helm S 2nd, Deer TR, Benyamin RM, et al. Percutaneous lumbar mechanical disc decompression utilizing Dekompressor®: an update of current evidence. Pain Physician. 2013;16:SE1–24.

    PubMed  Google Scholar 

  27. Zhou Y. Diagnosis and minimally invasive treatment of lumbar discogenic pain. In: Smith HS, editor. Current therapy in pain. Philadelphia: Saunders Elsevier; 2009. p. 620–5.

    Chapter  Google Scholar 

  28. Hellinger S. Treatment of contained lumbar disc herniations using radiofrequency assisted micro-tubular decompression and nucleotomy: four year prospective study results. Int J Spine Surg. 2014;8. https://doi.org/10.14444/1024.

    Google Scholar 

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Ajax Yang

  2. Lenox Hill Hospital, New York, NY, USA

    Sudhir Diwan

  3. Manhattan Spine and Pain Medicine, New York, NY, USA

    Sudhir Diwan

Authors
  1. Ajax Yang
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  2. Sudhir Diwan
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Correspondence to Sudhir Diwan .

Editor information

Editors and Affiliations

  1. Lenox Hill Hospital, New York, New York, USA

    Sudhir Diwan

  2. The Center for Pain Relief, Charleston, West Virginia, USA

    Timothy R Deer

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Yang, A., Diwan, S. (2018). Minimally Invasive Percutaneous Endoscopic Discectomy: Transdiscal Approach. In: Diwan, S., Deer, T. (eds) Advanced Procedures for Pain Management. Springer, Cham. https://doi.org/10.1007/978-3-319-68841-1_5

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  • DOI: https://doi.org/10.1007/978-3-319-68841-1_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-68839-8

  • Online ISBN: 978-3-319-68841-1

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