Table Of ContentEndoscopic
Procedures on
the Spine
Jin-Sung Kim
Jun Ho Lee
Yong Ahn
Editors
123
Endoscopic Procedures on the Spine
Jin-Sung Kim • Jun Ho Lee • Yong Ahn
Editors
Endoscopic Procedures
on the Spine
Editors
Jin-Sung Kim Jun Ho Lee
Department of Neurosurgery Department of Neurosurgery
Seoul St Mary’s Hospital Kyung Hee University Medical Center
College of Medicine, The Catholic Seoul
University of Korea, Seocho gu South Korea
Seoul
South Korea
Yong Ahn
Department of Neurosurgery
Gachon University Gil Medical Center
Incheon
South Korea
ISBN 978-981-10-3904-1 ISBN 978-981-10-3905-8 (eBook)
https://doi.org/10.1007/978-981-10-3905-8
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Foreword 1
Minimally invasive spine surgery (MISS) might be one of the most preferred
subspecialties of spine surgeons, especially young surgeons. It stands for
theoretically minimal damages to the surrounding tissues and yet maximal
efficiency in handling the main lesion. The main concept of this technology
should be a final object of spine surgery, because it must be a surgeons’ dream
to achieve the so-called surgical success in the state of preservation of physi-
ologic functions including spinal motion and in the state of maintaining the
normal spinal architecture.
Among MISS procedures, the endoscopic procedures have accounted for
a considerable portion of MISS and keep expanding its portion nowadays.
Endoscopy technology had continuously developed along with endoscopes
and their related devices since the early 1980s, the early stage of endoscopy.
By the 2000s, however, endoscopic procedures, particularly transforaminal
techniques, encountered their limitations, including the removal of far-
migrated disc fragments, stenosis, and lack of usability in the cervical and
thoracic spines. The measures to get over these limitations had been devel-
oped. But most of these measures required a highly experienced hand and are
time-consuming without merit.
The endoscopy has been indebted to high technology and innovative sci-
ence for its current advancement. Recently, a couple of new endoscopic pro-
cedures have been introduced as a limitation countermeasure and as a means
to explore the epidural space. If representative procedures are introduced,
they are “PSLD” (percutaneous stenoscopic lumbar decompression) via
interlaminar access and “SELD” (trans-sacral epiduroscopic lumbar decom-
pression). Substantially, no spine diseases, particularly in the degenerative
disease, become beyond what endoscopic procedures can deal with in the
near future.
Endoscopic technology in spine surgery is a daunting challenge for sur-
geons, as it requires steep learning curve and a great deal of experience. The
contribution and efforts of the world’s well-known endoscopic surgeons and
scientists made this book. I am certain that the editors demonstrate their com-
petence by reaping the honorable harvest of an invaluable book, through
which surgeons intending to challenge endoscopic procedures are able to take
the bird’s eye view of the endoscopic procedures and to find out the best way
to beat the challenge.
v
vi Foreword 1
My congratulations to Drs. J S Kim, J H Lee, and Y Ahn for their contribu-
tion and dedication to this complicated task.
July 31, 2017 Chun-Kun Park
Good Doctor Teun Teun Hospital
Anyang, South Korea
Foreword 2
The evolution of spine surgical technology is a moving target. The goal is
defined by the Hippocratic principle: First, do no harm to the patient.
We as surgeons are obliged to achieve the surgical goal (e.g., interbody
fusion, decompression, etc.) in a way which keeps the risk for the patient as
low as possible and the clinical and technical success as high as possible.
Whereas in the early days of spine surgery the surgical goal was para-
mount, little care was taken for the anatomic collateral damage which was
produced. This led to many frustrations, bad outcomes, complications, and
reoperations which, on the other hand, created a very critical perception of
spine surgery in the public opinion. Even nowadays, we as surgeons are con-
fronted with this.
Improved diagnostic technology has improved our knowledge about spi-
nal pathologies as well as about spinal topographic and functional anatomy.
The continuous technical developments such as implants, instruments,
“visualization” tools (surgical microscope, surgical endoscope), or computer-
assisted navigation have triggered surgical technique in a way that not only
the goal of surgery but also how to achieve it have been accepted as major
scientific challenges.
The so-called minimally invasive spine surgery (MISS) was born which
describes smaller and lesser-invasive surgical approaches to achieve the same
surgical and clinical goals as with “conventional” approaches.
Endoscopic surgery is the least-invasive technology of MISS. This book
describes in more than 30 chapters the absolute “cutting edge” of spinal
endoscopic technology for a large variety of spinal pathologies.
A selected group of global innovators, key opinion leaders, and trendset-
ters in MISS have shared their experiences and visions in this book which
should become a mandatory lecture as well as an inspiration for the youngest
generation of spine surgeons.
Despite all the enthusiasm and visionary ideas, we should not forget that
many of these techniques are “innovative,” that they require adequate teach-
ing and learning, and that they have their “learning curves.”
Scientific workup of outcomes and complications, adequate training, and
responsible use of it should always guide us in our daily practice when we
adopt such techniques.
vii
viii Foreword 2
I strongly believe that the term “minimally invasive spine surgery” will
disappear over time once these new techniques have stood the proof of time
and have become common standard surgical techniques.
Michael Mayer
Schön Klinik München Harlaching, FIFA Medical Center of Excellence
Academic Teaching Hospital Paracelsus Medical University Salzburg
München, Germany
Eurospine—The Spine Society of Europe
Uster, Switzerland
German Spine Society
München, Germany
Preface
Since the percutaneous endoscopic lumbar discectomy was introduced in the
mid-1980 to 1990, so many continuous efforts have been initiated and contin-
ued to endoscopic instrument system by which patients had better outcomes
than before.
Recently, the evidence of endoscopic spine surgery is now overwhelming;
even though most of them are not high-level evidence, that operations, which
previously required open spinal surgery, could now be performed safely by
endoscopic spinal surgery, without compromising the efficacy of the surgery.
As you know, endoscopic spinal surgery, compared with open spinal surgery,
offers patients comparable or reduced morbidity, short hospital stays, and
earlier return to daily activity. As an editor in chief, I hope that all spine sur-
geons need to understand MISS and learn the techniques of the various kinds
of endoscopic spine surgery, regardless of where they are in their careers, to
offer these benefits to patients.
The purpose of this book is to enable the spine surgeons who are keen to
agree with and learn the state of the art of endoscopic spine surgery. This
book describes the current indications; basic, advanced endoscopic tech-
niques; and future perspectives by the expert spine surgeons in the field. This
book also provides information on surgical “tips and pearls” on the emerging
endoscopic spine surgical techniques such as bi-portal endoscopic surgery
and endoscopic decompression for spinal stenosis.
I really appreciate all the international and national authors for their
energy, considerable time, and effort for this book. I hope this book would be
a milestone and key reference for endoscopic spine surgery with a rapid
evolution.
Seoul, South Korea Jin-Sung Luke Kim
ix
Contents
1 Spinal Endoscopy: Historical Review and
Current Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
C. Birkenmaier
2 Currently Available Equipment Details in the Market . . . . . . . . 9
Dirk Goethel
Part I C ervical Spinal Endoscopy
3 Anatomical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Jun Ho Lee
4 Ventrally Approached Cervical Endoscopy . . . . . . . . . . . . . . . . . 33
Yong Ahn
5 Posteriorly Approached Cervical Endoscopy . . . . . . . . . . . . . . . . 43
Samuel Won, Chi Heon Kim, and Chun Kee Chung
6 Cervical Endoscopy Using Transcorporeal Route . . . . . . . . . . . . 57
Jun Ho Lee
Part II T horacic Spinal Endoscopy
7 Thoracic Spinal Endoscopy- Anatomical Considerations . . . . . . 67
Mazda K. Turel, Mena G. Kerolus, Brian T. David,
and Richard G. Fessler
8 Indications of Thoracic Spinal Endoscopy: Background
of Thoracic Disc Herniation and Endoscopic Treatment . . . . . . 71
Sang Ha Shin
9 Posteriorly Approached Thoracic Endoscopy and Hybrid . . . . . 75
Nicholas Ahye, Arko Leopold IV, and Bong-Soo Kim
Part III Lumbar Spinal Endoscopy
10 Anatomical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Zhen-Zhou Li
xi
