Current techniques of endoscopic decompression in spine surgery

Abstract

Endoscopic spine surgery has become a practical, minimally invasive technique for decompression in patients with spinal disc herniation or stenosis. This review aimed to summarize the current techniques of endoscopic decompression technique in spine surgery and to discuss the benefits, limitations, and future perspectives of this minimally invasive technique. Endoscopic spine decompression surgery can be categorized according to the endoscopic property: percutaneous endoscopic (full-endoscopic), microendoscopic, and biportal endoscopic. It can also be classified based on the approach: transforaminal, interlaminar, anterior, posterior, and caudal approaches. Theoretically, each technique can be applied in the lumbar, cervical, and thoracic spine. The various endoscopic spine surgery techniques should be appropriately conducted according to the disease entities, level, and zone of pathologies. Although the current level of evidence is relatively low and the relevance of the technique is controversial, recent clinical results and the critical concept are promising. Development in optics, instruments, and approach will improve its safety and reduce technical complexity. In the meantime, high-quality clinical studies, including randomized trials and meta-analyses, are due for publication. Eventually, endoscopic spine surgery is expected to become the golden standard for spinal surgery.

Keywords: Disc herniation; endoscopic; minimally invasive; percutaneous; stenosis.

Figure 1

Categories of the endoscopic system used for endoscopic spine surgery. (A) Percutaneous endoscopic (or full-endoscopic) system. A working channel endoscope containing the optical device and working channel in a single portal; (B) microendoscopic system with the optical device attached to the tubular retractor; (C) biportal endoscopic system with separate endoscopic viewing and working channels.

Figure 2

Methods of approach. (A) Transforaminal (posterolateral) approach for lumbar/thoracic spine; (B) interlaminar (posterior) approach for lumbar/thoracic spine; (C) anterior approach for cervical spine; (D) posterior approach for cervical spine; (E) caudal approach for lumbosacral spine.