Posterior Endoscopic Lumbar Discectomy Using a Thoracoport as a Tubular Retractor

 

 Buy Article Permissions and Reprints

Abstract

Objective: To make lumbar discectomy simple and feasible, we developed an endoscopic surgical technique that uses a Thoracoport as a tubular retractor.

Surgical technique: The patient was placed in a 60-degree forwardly inclined lateral position with the side of the lesion on the top. After radiological confirmation of the index level, a Thoracoport was inserted through a 2-cm paramedian transverse skin incision. A 0-degree rod lens endoscope was mounted to a scope holder and placed into the retractor for magnification and illumination. Laminotomy was performed with a high-speed drill to reach the insertion of the yellow ligament to the upper lamina. A 2-mm undercutting of the upper facet was performed with a punch to expose the lateral edge of the nerve root. Surgical instruments were inserted next to the endoscope for manipulation. The herniated disc was identified and removed with pituitary rongeurs as in a standard microdiscectomy. With this technique, a sufficient amount of bone is resected to expose the disc lateral to the nerve root; hemostasis is easily achieved and the incidence of nerve root injury is reduced.

Conclusion: We have successfully performed an endoscopic lumbar discectomy in 20 patients by using a Thoracoport as a tubular retractor. No specially designed instruments were required. This technique was a safe and effective minimally invasive approach to treating lumbar disc disease according to our preliminary experience.

References

• 1 Smith L. Enzyme dissolution of the nucleus pulposus in humans.  JAMA. 1964;  187 137-140
  CrossrefPubMedGoogle Scholar
• 2 Maroon J C. Current concepts in minimally invasive discectomy.  Neurosurgery. 2002;  51 (suppl. 2) 137-145
  PubMedGoogle Scholar
• 3 Hijikata S. Percutaneous nucleotomy: a new concept technique and 12 years experience.  Clin Orthop. 1989;  238 9-23
  PubMedGoogle Scholar
• 4 Onik G, Mooney V, Maroon J C, Wiltse L, Helms C, Schweigel J, Watkins R, Kahanovitz N, Day A, Morris J. Automated percutaneous discectomy: A prospective multi-institutional study.  Neurosurgery. 1990;  26 228-232
  PubMedGoogle Scholar
• 5 Choy D S, Case R B, Fielding W, Hughes J, Liebler W, Ascher P. Percutaneous laser nucleolysis of lumbar discs.  N Engl J Med. 1987;  317 771-772
  PubMedGoogle Scholar
• 6 Schreiber A, Suezawa Y. Transdiscoscopic percutaneous nucleotomy in disc herniation.  Orthop Rev. 1986;  15 35-38
  PubMedGoogle Scholar
• 7 Mayer H M, Brock M. Percutaneous endoscopic discectomy: Surgical technique and preliminary results compared to microsurgical discectomy.  J Neurosurg. 1993;  78 216-225
  CrossrefPubMedGoogle Scholar
• 8 Yeung A T, Tsou P M. Posterolateral endoscopic excision for lumbar disc herniation.  Spine. 2002;  27 722-731
  CrossrefPubMedGoogle Scholar
• 9 Foley K T, Smith M M. Microendoscopic discectomy.  Tech Neurosurg. 1997;  3 301-307
  PubMedGoogle Scholar
• 10 Brayda-Bruno M, Cinnella P. Posterior endoscopic discectomy (and other procedures).  Eur Spine J. 2000;  9 (suppl. 1) S24-S29
  CrossrefPubMedGoogle Scholar
• 11 Perez-Cruet M J, Foley K T, Isaacs R E, Rice-Wyllie L, Wellington R, Smith M M, Fessler R G. Microendoscopic lumbar discectomy: technical note.  Neurosurgery. 2002;  51 (suppl. 2) 129-136
  PubMedGoogle Scholar
• 12 Jho H D. Endoscopic transpedicular thoracic discectomy.  J Neurosurg. 1999;  91 151-156
  PubMedGoogle Scholar
• 13 Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T. Microendoscopic discectomy (MED) for lumbar disc prolapse.  J Clin Neurosci. 2003;  10 231-235
  CrossrefPubMedGoogle Scholar

Po-Chun HsiehM. D. 

Department of Neurosurgery · China Medical University Hospital

7F-5 No. 55, Chung-Tai East Road

Taichung - Taiwan

Republic of China ·

Phone: +886-4-2208-0519

Fax: +886-4-2208-0541

Email: andrewhsieh@giga.net.tw