Adjunctive Techniques for Foraminal Endoscopic Microdiscectomy
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Minimally invasive surgical techniques in the lumbar spine was first scientifically studied and validated with chymopapain intradiscal nucleolysis. Two large randomized double blind and 30 cohort studies validate its efficacy and advantages over placebo. Endoscopic spine surgery has similarly been studied and validated by Kambin and Mayer with prospective studies. Other techniques continue to be introduced, but many fall out of favor later when surgeons compare them with the more familiar “gold standard” microdiscectomy.
This is at least partially due to the narrowed indications for these techniques when the technique is used as an isolated procedure. It may also be due to the technical difficulty of learning a new technique not routinely available in academic programs and getting acclimated to two dimentional images rather than the three dimensional visualization that surgeons have come to rely on. The adjunctive utilization of minimally invasive technologies such as chymopapain and laser, to augment disc decompression has the improved, advanced, and evolved endoscopic disc and foraminal surgery.
In minimally invasive spine surgery, endoscopic surgery is establishing a new, alternative standard. The incorporation of a combination of minimally invasive technologies enhances each individual technique, making it more intuitive to surgeons. The trend of combining technologies will improve and evolve both new and innovative technologies. Such is the case for endoscopic transforaminal disc surgery, beginning with endoscopic disc excision.