Skip to main content

Indications

  • Chapter
  • First Online:
Endoscopic Procedures on the Spine
  • 846 Accesses

Abstract

The indications for surgical treatment of lumbar intervertebral disc herniation under the percutaneous spinal endoscope are introduced in detail. A systematic introduction is made to the percutaneous endoscopic surgical technique selection for different types of lumbar disc herniation. Details of the percutaneous endoscopic surgical stratagy that should be used for various types and locations of lumbar spinal stenosis are also introduced. The indications and surgical techniques for the treatment of discopenic low back pain, chronic facet joint pain, and lumbar instability are also briefly introduced. The use of percutaneous endoscopic surgical techniques for the treatment of lumbar fractures, osteoid osteomas and other diseases is also forward-looking.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection. Eur Spine J. 2010;19(7):1087–93. https://doi.org/10.1007/s00586-009-1274-4.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kim CH, Chung CK, Woo JW. Surgical Outcome of Percutaneous Endoscopic Interlaminar Lumbar Discectomy for Highly Migrated Disk Herniation. Clin Spine Surg. 2016;29(5):E259–66. https://doi.org/10.1097/BSD.0b013e31827649ea.

    Article  PubMed  Google Scholar 

  3. Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, Shin SW. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J. 2007;16(3):431–7. https://doi.org/10.1007/s00586-006-0219-4.

    Article  PubMed  Google Scholar 

  4. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27(7):722–31.

    PubMed  Google Scholar 

  5. Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine. 2005;30(22):2570–8.

    PubMed  Google Scholar 

  6. Li ZZ, Hou SX, Shang WL, Song KR, Zhao HL. Modified percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar discectomy: instrument design, technique notes, and 5 years follow-up. Pain Physician. 2017;20(1):E85–98.

    PubMed  Google Scholar 

  7. Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, Shin SW, Kang HY. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine. 2006;31(10):E285–90. https://doi.org/10.1097/01.brs.0000216446.13205.7a.

    Article  PubMed  Google Scholar 

  8. Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine. 2008;33(15):E508–15. https://doi.org/10.1097/BRS.0b013e31817bfa1a.

    Article  PubMed  Google Scholar 

  9. Wang D, Pan H, Hu Q, Zhu H, Zhu L, He Y, Wang J, Jia G. Percutaneous endoscopic transpedicle approach for herniated nucleus pulposus in the lumbar hidden zone. Asian J Endosc Surg. 2017;10(1):87–91. https://doi.org/10.1111/ases.12320.

    Article  PubMed  Google Scholar 

  10. Li ZZ, Hou SX, Shang WL, Song KR, Zhao HL. The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach. Clin Neurol Neurosurg. 2015;133:40–5. https://doi.org/10.1016/j.clineuro.2015.03.003.

    Article  PubMed  Google Scholar 

  11. Suh SW, Shingade VU, Lee SH, Bae JH, Park CE, Song JY. Origin of lumbar spinal roots and their relationship to intervertebral discs: a cadaver and radiological study. J Bone Joint Surg. 2005;87(4):518–22. https://doi.org/10.1302/0301-620X.87B4.15529.

    Article  CAS  Google Scholar 

  12. Cinotti G, De Santis P, Nofroni I, Postacchini F. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine. 2002;27(3):223–9.

    PubMed  Google Scholar 

  13. Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, Kang HS. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol. 2010;194(4):1095–8. https://doi.org/10.2214/AJR.09.2772.

    Article  PubMed  Google Scholar 

  14. Hasegawa T, An HS, Haughton VM, Nowicki BH. Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am. 1995;77(1):32–8.

    CAS  PubMed  Google Scholar 

  15. 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.

    PubMed Central  Google Scholar 

  16. Knight MT, Jago I, Norris C, Midwinter L, Boynes C. Transforaminal endoscopic lumbar decompression & foraminoplasty: a 10 year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery. Int J Spine Surg. 2014;8 https://doi.org/10.14444/1021.

    PubMed Central  Google Scholar 

  17. Ahn Y, Lee SH, Park WM, Lee HY. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg. 2003;99(3 Suppl):320–3.

    PubMed  Google Scholar 

  18. Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine. 1988;13(3):313–20.

    CAS  PubMed  Google Scholar 

  19. Ciric I, Mikhael MA. Lumbar spinal-lateral recess stenosis. Neurol Clin. 1985;3(2):417–23.

    CAS  PubMed  Google Scholar 

  20. Li ZZ, Hou SX, Shang WL, Cao Z, Zhao HL. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: technique notes and 2 years follow-up. Clin Neurol Neurosurg. 2016;143:90–4. https://doi.org/10.1016/j.clineuro.2016.02.008.

    Article  PubMed  Google Scholar 

  21. Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine. 2009;10(5):476–85. https://doi.org/10.3171/2008.7.17634.

    Article  PubMed  Google Scholar 

  22. Park HJ, Kim SS, Lee YJ, Lee SY, Park NH, Choi YJ, Chung EC, Rho MH. Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis. Br J Radiol. 2013;86(1025):20120180. https://doi.org/10.1259/bjr.20120180.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skelet Radiol. 2011;40(8):1033–9. https://doi.org/10.1007/s00256-011-1102-x.

    Article  Google Scholar 

  24. Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, Merk H, Godolias G, Ruetten S. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician. 2015;18(1):61–70.

    PubMed  Google Scholar 

  25. Lee CK, Vessa P, Lee JK. Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine. 1995;20(3):356–61.

    CAS  PubMed  Google Scholar 

  26. Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis. 1995;54(2):100–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Schellhas KP, Pollei SR, Gundry CR, Heithoff KB. Lumbar disc high-intensity zone. Correlation of magnetic resonance imaging and discography. Spine. 1996;21(1):79–86.

    CAS  PubMed  Google Scholar 

  28. Sachs BL, Vanharanta H, Spivey MA, Guyer RD, Videman T, Rashbaum RF, Johnson RG, Hochschuler SH, Mooney V. Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine. 1987;12(3):287–94.

    CAS  PubMed  Google Scholar 

  29. 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(5):564–73. https://doi.org/10.1016/j.spinee.2004.01.014.

    Article  PubMed  Google Scholar 

  30. Lee JH, Lee SH. Clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty for treatment of patients with discogenic low back pain. Pain Med. 2016;17(4):650–7. https://doi.org/10.1093/pm/pnv120.

    Article  PubMed  Google Scholar 

  31. Ahn Y, Lee SH. Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain. Acta Neurochir. 2010;152(10):1695–702. https://doi.org/10.1007/s00701-010-0726-2.

    Article  PubMed  Google Scholar 

  32. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994;19(10):1132–7.

    CAS  PubMed  Google Scholar 

  33. Helbig T, Lee CK. The lumbar facet syndrome. Spine. 1988;13(1):61–4.

    CAS  PubMed  Google Scholar 

  34. Eisenstein SM, Parry CR. The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes. J Bone Joint Surg. 1987;69(1):3–7.

    CAS  Google Scholar 

  35. Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. Spine J. 2008;8(1):56–64. https://doi.org/10.1016/j.spinee.2007.10.010.

    Article  PubMed  Google Scholar 

  36. Hickey RF, Tregonning GD. Denervation of spinal facet joints for treatment of chronic low back pain. N Z Med J. 1977;85(581):96–9.

    CAS  PubMed  Google Scholar 

  37. Moussa WM, Khedr W. Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome. Clin Neurol Neurosurg. 2016;150:96–104. https://doi.org/10.1016/j.clineuro.2016.09.004.

    Article  PubMed  Google Scholar 

  38. Cho J, Park YG, Chung SS. Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome. Stereotact Funct Neurosurg. 1997;68(1–4 Pt 1):212–7.

    CAS  PubMed  Google Scholar 

  39. Li ZZ, Hou SX, Shang WL, Song KR, Wu WW. Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain. Clin Neurol Neurosurg. 2014;126:11–7. https://doi.org/10.1016/j.clineuro.2014.08.014.

    Article  PubMed  Google Scholar 

  40. Yeung A, Gore S. Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study. Int J Spine Surg. 2014;8 https://doi.org/10.14444/1023.

    PubMed Central  Google Scholar 

  41. Klang E, Lidar M, Lidar Z, Aharoni D, Eshed I. Prevalence and awareness of sacroiliac joint alterations on lumbar spine CT in low back pain patients younger than 40 years. Acta Radiol. 2017;58(4):449–55. https://doi.org/10.1177/0284185116656490.

    Article  PubMed  Google Scholar 

  42. Vora AJ, Doerr KD, Wolfer LR. Functional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators. Phys Med Rehabil Clin N Am. 2010;21(4):679–709. https://doi.org/10.1016/j.pmr.2010.07.005.

    Article  PubMed  Google Scholar 

  43. Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. 1995;20(1):31–7.

    CAS  PubMed  Google Scholar 

  44. Cohen SP, Hurley RW, Buckenmaier CC 3rd, Kurihara C, Morlando B, Dragovich A. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008;109(2):279–88. https://doi.org/10.1097/ALN.0b013e31817f4c7c.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ferrante FM, King LF, Roche EA, Kim PS, Aranda M, Delaney LR, Mardini IA, Mannes AJ. Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med. 2001;26(2):137–42. https://doi.org/10.1053/rapm.2001.21739.

    Article  CAS  PubMed  Google Scholar 

  46. Choi WS, Kim JS, Ryu KS, Hur JW, Seong JH, Cho HJ. Endoscopic radiofrequency ablation of the sacroiliac joint complex in the treatment of chronic low back pain: a preliminary study of feasibility and efficacy of a novel technique. Biomed Res Int. 2016;2016:2834259. https://doi.org/10.1155/2016/2834259.

    Article  PubMed  PubMed Central  Google Scholar 

  47. James A, Laufer I, Parikh K, Nagineni VV, Saleh TO, Hartl R. Lumbar juxtafacet cyst resection: the facet sparing contralateral minimally invasive surgical approach. J Spinal Disord Tech. 2012;25(2):E13–7. https://doi.org/10.1097/BSD.0b013e31822ac4e5.

    Article  PubMed  Google Scholar 

  48. Deshmukh NV, Kanse P. Lumbar facet synovial cyst. Postgraduate Med J. 2003;79(933):419, 423-414

    CAS  Google Scholar 

  49. Zou MX, Lv GH, Li J, Wang XB. Osteoid osteoma at the posterior element of lumbar spinal column in a young boy. Spine J. 2016;16(10):e651–2. https://doi.org/10.1016/j.spinee.2016.02.026.

    Article  PubMed  Google Scholar 

  50. Even JL, O’Malley MJ, Ward WT. Osteoid osteoma of the lumbar spine. Spine J. 2012;12(10):971–2. https://doi.org/10.1016/j.spinee.2012.08.176.

    Article  PubMed  Google Scholar 

  51. Yoshioka K, Matsuda E, Murakami H, Tsuchiya H. Microendoscopic excision of osteoid osteoma in the pedicle of the third lumbar vertebra. Asian Spine J. 2015;9(6):958–61. https://doi.org/10.4184/asj.2015.9.6.958.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Slosar PJ Jr, Patwardhan AG, Lorenz M, Havey R, Sartori M. Instability of the lumbar burst fracture and limitations of transpedicular instrumentation. Spine. 1995;20(13):1452–61.

    PubMed  Google Scholar 

  53. Ducker TB. Lumbar burst fracture. J Spinal Disord. 1988;1(2):174–5; discussion 176–178

    CAS  PubMed  Google Scholar 

  54. Ko SB, Lee SW. Result of posterior instrumentation without fusion in the management of thoracolumbar and lumbar unstable burst fracture. J Spinal Disord Tech. 2014;27(4):189–95. https://doi.org/10.1097/BSD.0b013e31825bfc8e.

    Article  PubMed  Google Scholar 

  55. Kim HY, Kim HS, Kim SW, Ju CI, Lee SM, Park HJ. Short segment screw fixation without fusion for unstable thoracolumbar and lumbar burst fracture: a prospective study on selective consecutive patients. J Korean Neurosurg Soc. 2012;51(4):203–7. https://doi.org/10.3340/jkns.2012.51.4.203.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Eck JC. Minimally invasive corpectomy and posterior stabilization for lumbar burst fracture. Spine J. 2011;11(9):904–8. https://doi.org/10.1016/j.spinee.2011.06.013.

    Article  PubMed  Google Scholar 

  57. Alqarni AM, Schneiders AG, Hendrick PA. Clinical tests to diagnose lumbar segmental instability: a systematic review. J Orthop Sports Phys Ther. 2011;41(3):130–40. https://doi.org/10.2519/jospt.2011.3457.

    Article  PubMed  Google Scholar 

  58. O’Sullivan PB. Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management. Man Ther. 2000;5(1):2–12. https://doi.org/10.1054/math.1999.0213.

    Article  PubMed  Google Scholar 

  59. Fritz JM, Erhard RE, Hagen BF. Segmental instability of the lumbar spine. Phys Ther. 1998;78(8):889–96.

    CAS  PubMed  Google Scholar 

  60. Boden SD, Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine. 1990;15(6):571–6.

    CAS  PubMed  Google Scholar 

  61. Folman Y, Shabat S, Gepstein R. B-twin expandable spinal spacer for posterior lumbar interbody stabilization: mechanical testing. J Surg Orthop Adv. 2006;15(4):203–8.

    PubMed  Google Scholar 

  62. Folman Y, Lee SH, Silvera JR, Gepstein R. Posterior lumbar interbody fusion for degenerative disc disease using a minimally invasive B-twin expandable spinal spacer: a multicenter study. J Spinal Disord Tech. 2003;16(5):455–60.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Li, ZZ. (2020). Indications. In: Kim, JS., Lee, J., Ahn, Y. (eds) Endoscopic Procedures on the Spine. Springer, Singapore. https://doi.org/10.1007/978-981-10-3905-8_11

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-3905-8_11

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-3904-1

  • Online ISBN: 978-981-10-3905-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics