Multi-level spine endoscopy: A review of available evidence and case report

[摘要] In the last decade, there has been a significant shift from open to minimally invasive spinal surgical techniques to reduce ‘insult’ to the soft tissues and produce faster patient recovery. Although practised in a few centres from the 1970s onwards,1,2 recent advances in endoscopic techniques and equipment, including the availability of working channel endoscopes coupled to high-definition cameras, has led to an international revolution in patient care. In 1983, Kambin and Gellman3 described the safe working zone into which instruments could be placed by a transforaminal approach and it was subsequently recognised that this provided an ideal portal for endoscopic access.4 Following an initial series of case reports describing simple discectomy,5-7 refinements of technique led to several variations in surgical approach. Posterolateral transforaminal decompression started as an ‘inside-out’ approach accessing the disc through a lateral fenestration of the annulus and extracting fragments from the canal via the disc itself.8 However, with the development of better instruments and reamers to widen the foramen, most surgeons now favour an ‘outside-in’ approach,9,10 accessing the herniated disc from inside the spinal canal. Evidence supporting minimally invasive approaches and transforaminal endoscopic spinal surgery (TESS) in particular has grown exponentially over the last ten years.

[学科分类] 神经科学

[关键词] cervical endoscopic surgery;microdiscectomy;thoracic discectomy;transforaminal endoscopic discectomy;spinal surgery