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. 2020 Apr;10(2 Suppl):65S-69S.
doi: 10.1177/2192568219884913. Epub 2020 May 28.

The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review

Jason I Liounakos  1 , Michael Y Wang  1
Affiliations

The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review

Jason I Liounakos et al. Global Spine J. 2020 Apr.

Abstract

Study design: Review.

Objectives: To review the current state of endoscopic spine surgery with regard to discectomy, interbody fusion, and combination with Enhanced Recovery After Surgery programs in order to evaluate its relevance to the future of spine care.

Methods: A review of the literature and expert opinion is used to accomplish the objectives.

Results: The greatest strength of endoscopic spine surgery lies in its adherence to the basic tenets of minimally invasive surgery and its innate compatibility with Enhanced Recovery After Surgery programs, which aim to improve outcomes and reduce health care costs. The greatest challenge faced is the unique surgical skill set and significant learning curve.

Conclusions: Endoscopic spine surgery strives to achieve the core goals of minimally invasive surgery, while reducing cost and enhancing quality. In a healthcare market that is becoming increasingly burdened by cost and regulatory constraints, the utilization of endoscopy may become more widespread in the coming years.

Keywords: endoscopy; minimally invasive surgical procedures; spine.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Michael Y. Wang is a consultant for Depuy-Synthes Spine, K2M, Spineology, and Stryker; receives royalties from Children’s Hospital of Los Angeles, Depuy-Synthes Spine, Springer Publishing, and Quality Medical Publishing; is on the Advisory Board of Vallum; holds direct stock ownership in Innovative Surgical Devices; and receives support for a non–study-related clinical or research effort overseen by the US Department of Defense.

Figures

Figure 1.
Figure 1.
Kambin’s triangle. The triangle is bordered by the exiting nerve root (hypotenuse), the traversing nerve root (height), and the superior end-plate of the caudal vertebral body (base). The medial-most portion of the triangle provides the greatest window for safe access to the intervertebral disc.
Figure 2.
Figure 2.
Left interlaminar L5-S1 percutaneous endoscopic discectomy. (A) Axial T2-weighted magnetic resonance image through L5-S1 depicts a left paracentral herniated disc. (B) Endoscopic view of epidural fat after opening a window through the ligamentum flavum. (C) Pituitary rongeur simultaneously retracting the traversing S1 nerve root, while removing herniated disc. (D) Postdiscectomy, the decompressed thecal sac and traversing S1 nerve root are clearly visualized. C, caudal; L, lateral; M, medial; R, rostral.
Figure 3.
Figure 3.
Percutaneous discectomy and end-plate preparation for fusion following endoscopic decompression. (A) Fluoroscopic image showing disc removal using a hand drill. (B) Fluoroscopic image showing disc removal using a specialized curette. (C) Fluoroscopic image showing final end-plate preparation using a stainless steel brush. (D) Fluoroscopic image showing sequential filling of mesh interbody implant with allograft in order to obtain the desired intervertebral height.
Figure 4.
Figure 4.
Representative case of L3-L5 awake endoscopic minimally invasive transforaminal lumbar interbody fusion. (A) Preoperative lateral lumbar radiograph demonstrating intervertebral settling with top-down foraminal stenosis at L3-4 and L4-5. (B) Postoperative lateral lumbar radiograph after endoscopic decompression and interbody implant placement, with restoration of intervertebral height and foraminal decompression.
See this image and copyright information in PMC

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