Decompression for cervical disc herniation using the full-endoscopic anterior technique.

OBJECTIVE: Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach. INDICATION: Fresh disc herniation with monoradicular symptoms in the upper extremity. CONTRAINDICATIONS: Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity. SURGICAL TECHNIQUE: Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space. POSTOPERATIVE MANAGEMENT: Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6. RESULTS: A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.

[The trend towards full-endoscopic decompression : Current possibilities and limitations in disc herniation and spinal stenosis]. / Der Trend zu vollendoskopischen Dekompressionen : Aktuelle Möglichkeiten und Grenzen bei Bandscheibenvorfall und Spinalkanalstenose.

BACKGROUND: The most frequent causes of degenerative constrictions of the spinal canal are disk herniations and spinal stenoses. The lumbar and cervical spine is the most affected. SURGICAL PROCEDURES: After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical decompression is regarded as the standard procedure in the lumbar region, while in the cervical spine, microsurgical anterior decompression and fusion are standard. Full-endoscopic techniques for decompression are becoming increasingly widespread worldwide. The development of various surgically created approaches and appropriate instrument sets have made the full-endoscopic operation of disk herniations and spinal stenosis possible. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the approaches depends on anatomical and pathological inclusion and exclusion criteria. RESULTS: The clinical results of standard procedures have been achieved, which must be regarded as a minimum criterion for the introduction of new technologies. On the basis of EBM criteria, it can be established that using the full-endoscopic techniques developed, adequate decompression is achieved in the defined indications with reduced traumatization, improved visibility conditions, and positive cost benefits. Today, full-endoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.

[Decompression for cervical disc herniation using the full-endoscopic anterior technique - German version]. / Dekompression beim zervikalen Bandscheibenvorfall in vollendoskopischer, ventraler Technik.

OBJECTIVE: Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach. INDICATION: Fresh disc herniation with monoradicular symptoms in the upper extremity. CONTRAINDICATIONS: Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity. SURGICAL TECHNIQUE: Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space. POSTOPERATIVE MANAGEMENT: Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6. RESULTS: A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.

Full-endoscopic posterior foraminotomy surgery for cervical disc herniations.

OBJECTIVE: Surgery for cervical disc herniation with full-endoscopic posterior access. INDICATIONS: Cervical disc herniation and neuroforaminal pathology with radicular symptoms. CONTRAINDICATIONS: Neck pain alone, cervical myelopathy or pathologies with central nervous system symptoms, instabilities requiring correction/instabilities. SURGICAL TECHNIQUE: Introduction of a surgical tube to the facet joint at the level to be operated on. Resection of bony and ligamentous parts of the cervical spinal canal under endoscopic guidance. Visualisation of the disc herniation and decompression of the neural structures. POSTOPERATIVE MANAGEMENT: Immediate mobilisation, specific rehabilitative physiotherapy depending on pre-existing neurological deficits. RESULTS: A total of 87 patients underwent full-endoscopic posterior surgery and were followed over a period of 2 years. Significant improvement was observed. No serious complications occurred. In all, 5 patients underwent revision in the follow-up period. Of the patients, 93% would undergo the procedure again.

[Decompression of lumbar lateral spinal stenosis: full-endoscopic, interlaminar technique]. / Dekompression der lumbalen Rezessusstenose : Endoskopische, interlaminäre Technik.

OBJECTIVE: Decompression in lumbar recess stenosis in a full-endoscopic technique using an interlaminar approach. INDICATIONS: Lumbar recess stenosis due to ligamentous, osseous, discogenic compression, and/or juxta-facet cysts. CONTRAINDICATIONS: Pure back pain, instability/deformity requiring correction, pure foraminal stenosis. SURGICAL TECHNIQUE: Introduction of a surgical sleeve to the intralaminar window. Endoscopic resection of compressing bony/ligamentary structures and also of osteophytes or parts of annulus. POSTOPERATIVE MANAGEMENT: Immediate mobilization, isometric/coordination exercises, functional exercises from week 3, building up strength from week 6. RESULTS: A total of 192 patients underwent full-endoscopic surgery or microsurgery and were followed up over a minimum of 2 years. A significant improvement was revealed. Serious complications occurred in 5% and were significantly reduced in the endoscopic group. Five patients were revised with decompression and/or fusion. Eighty-nine percent would undergo the operation again.

A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients.

Anterior cervical decompression and fusion (ACDF) is the standard procedure for operation of cervical disc herniations with radicular arm pain. Mobility-preserving posterior foraminotomy is the most common alternative in the case of a lateral localization of the pathology. Despite good clinical results, problems may arise due to traumatization of the access. Endoscopic techniques are considered standard in many areas, since they may offer advantages in surgical technique and rehabilitation. These days, all disc herniations of the lumbar spine can be operated in a full-endoscopic technique. The objective of this prospective study was to examine the technical possibilities of full-endoscopic posterior foraminotomy in the treatment of cervical lateral disc herniations. 87 patients were followed for 2 years. The results show that 87.4% no longer have arm pain and 9.2% have only occasional pain. The decompression results were equal to those of conventional procedures. The operation-related traumatization was reduced. The recurrence rate was 3.4%. No serious surgical complications occurred. The recorded results show that the full-endoscopic posterior foraminotomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.

A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients.

Even with good results, conventional disc operations may result in consecutive damage due to traumatisation. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. The transforaminal operation is the most common full-endoscopic procedure in surgery of the lumbar spine. It is frequently necessary to reach the spinal canal directly in order to achieve sufficient resection of lumbar disc herniations. Even in using a lateral approach, the authors recognise the clear limitations of the transforaminal procedure. The objective of this prospective study was to examine the technical possibility of a full-endoscopic interlaminar access. The focus was on questions of sufficient decompression, as well as advantages and disadvantages of the minimally invasive procedure. 331 patients were followed for 2 years. The results show that 82 % reported no longer having leg pain, and 13 % had only occasional pain. The decompression results are equivalent to those of conventional procedures. Traumatisation of both the access pathway and the spinal canal structures was reduced. Epidural scarring was minimised. The recurrence rate was 2.4 %. No serious surgical complications were observed. The authors view the technique described, which offers the advantage of a truly minimally invasive procedure, as a sufficient and safe alternative to conventional procedures, when the appropriate indication criteria are heeded. There are technical problems because of the small instruments. In conjunction with the transforaminal procedure, this is an expansion of the spectrum for full-endoscopic surgery of lumbar disc herniations.

[Spinal cord stimulation (SCS) using an 8-pole electrode and double-electrode system as minimally invasive therapy of the post-discotomy and post-fusion syndrome--prospective study results in 34 patients]. / Spinal-Cord-Stimulation (SCS) mittels 8-poligem Elektroden- und Doppelelektroden-System als minimalinvasive Therapie beim Postdiskotomie- und Postfusionssyndrom - Prospektive Studienergebnisse von 34 Patienten.

AIM: Therapy of a pronounced post-discotomy (PDS) and post-fusion syndrome (PFS) is often unsatisfactory because of the complexity and multifactorial pain genesis. If surgical interventions cannot promise relief and if the entire interdisciplinary spectrum of conservative treatment measures is inadequate, the area of neuromodulative procedures offers spinal cord stimulation (SCS). The objective of this study was to examine the therapeutic possibilities of SCS using an 8-pole electrode and double electrode system in PDS and PFS with extensive back-leg pain areas. METHOD: An appropriate SCS system was implanted in 34 patients with PDS and PFS. Follow-up examinations were made prospectively over a period of 24 months using general criteria and psychometric test measuring instruments validated for German-language use. RESULTS: An 8-pole double electrode system was implanted 23 times, a single electrode sufficed in 11 cases. The area of pain was covered in all patients. This required special technical capabilities of the SCS system. The results remained constant over 24 months. The morphine dose could be reduced by at least 50 %. All measuring instruments confirmed a clear reduction in pain and improvement in quality of life as a result of SCS implantation. CONCLUSION: The SCS is an minimally invasive surgical procedure which can enlarge the therapeutical possibilities of pronounced PDS and PFS resistant to other modes of treatment. Special technical possibilities of parameter setting are required to cover the pain areas.