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Category: Book Chapters

Advanced Spinal Surgery Technologies

Endoscopic disc surgery is evolving rapidly due to improvements in surgical technique, endoscope design, and instrumentation. These third generation systems with excellent optics give the endoscopic spine surgeon the ability to probe spinal anatomy in a conscious patient and evaluate the pathologic process causing the patient’s pain. Now that spinal endoscopy can be performed, conditions previously not even considered for surgery may be evaluated and managed.

Patients previously not candidates for traditional surgery may find relief with endoscopic spine surgery directed toward the pain generator. Our understanding of discogenic back is enhanced by diagnostic and surgical endoscopy of the lumbar spine, as endoscopic visualization of pathologic lesions not previously seen with traditional techniques are increasing our understanding of the pain generators in the lumbar spine.

Arthroscopic Lumbar Decompression: The Foraminal Approach

Endoscopic disc surgery is evolving rapidly because of improvements in surgical technique, endoscope design, and instrumentation. These third-generation systems with excellent optics give the endoscopic spine surgeon the ability to probe spinal anatomy in a conscious patient and evaluate the pathologic process causing the patient’s pain. Now that spinal endoscopy can be performed, conditions previously not even considered for surgery may be evaluated and managed.

Patients who previously were not candidates for traditional surgery may find relief with endoscopic spine surgery directed toward the pain generator. Our understanding of discogenic back pain is enhanced by diagnostic and surgical endoscopy of the lumbar spine, as endoscopic visualization of pathologic lesions not previously seen with traditional techniques is increasing our understanding of the pain generators in the lumbar spine.

Selective Endoscopic Discectomy™ : Twelve Years Experience

More than Twelve years have passed (1991) since I learned and adopted Arthroscopic Microdiscectomy from pioneer endoscopic spine surgeon Parviz Kambin, who, along with Sadahisa Hijikata, first established the technique for percutaneous nucleotomy in the early 1970’s. A cadaver dissection of the traditional posterior anatomy of the lumbar spine compared with the foraminal anatomy clearly illustrates the feasibility and advantages of the foraminal approach to the lumbar disc.

Endoscopic Discectomy and Foraminal Decompression In Interventional Spine: An Algorithmic Approach

Endoscopic disc surgery is evolving rapidly because of improvements in surgical technique, endoscope design, adjunctive surgical tools, and instrumentation. New endoscopes and complementary surgical devices enhances the endoscopic spine surgeon’s ability to also probe spinal anatomy in a conscious patient. The surgeon can then evolve his diagnostic and surgical skills with this newly found ability to evaluate pathologic, anatomic, and physiologic processes causing the patient’s pain.

Now that diagnostic spinal endoscopy can be performed, conditions previously not even considered for surgery may be probed, evaluated and surgically treated with greater accuracy. Our understanding of discogenic back pain is enhanced, as endoscopic visualization of pathologic lesions not previously seen, intradiscally and in the “hidden” extra-foraminal zone is increasing our understanding of the pain generators in the lumbar spine.

Microtherapy in Low Back Pain

Experimental in vivo stimulation of the annulus fibrosus of an intervertebral disc produced back pain, and the term “discogenic pain” was coined to establish the association between annulus stimulation and the subjective pain perception. Histologically the end organ neural sensors are located in the outer layers of the annulus, epiannular surface, and the juxta endplate region. Nucleus pulposus and its metabolic byproducts are known contact irritants to the nerve tissues and are known to reduce their membrane excitation threshold. There is no direct contact between the neural end sensors and the intradiscal irritants in an intact disc.

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