| Procedures: Lumbar Microendoscopic Discectomy |
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 Keywords Lumbar Herniated Disc Lumbar Lateral Recess Stenosis Lumbar Microendoscopic Disectomy Lumbar Pinched Nerve Lumbar Minimally Invasive Surgery Definition MicroEndoscopic Surgery in the lumbar spine (low back) continues the revolution in the Minimally Invasive Spinal Surgery arena. MicroEndoscopic Discectomy employs all the basic advantages of traditional spinal microsurgery: 1. illumination and magnification 2. decompression of the affected spinal nerve with direct visualization of the nerve. Why consider MicroEndoscopic Surgery for the Herniated Disc? The potential advantages are numerous: 1. Outpatient Surgery 2. Less incision pain. 3. 14mm, 16mm or 18mm entry via "band aid style" incision with minimal alteration of normal tissue. 4. Percutaneous surgery importing the experience derived from traditional spinal microsurgery (the surgeon sees what he/she is doing). 5. Faster potential return to work and to routine life activities due to minimal alteration in the normal anatomy. Indications Indications for MicroEndoscopic Discectomy are the same as traditional traditional lumbar microsurgery. The patient should have leg and/or buttock pain, or leg weakness, and an unequivocal imaging study (M.R.I., Myelogram, Contrast enhanced C.A.T. scan, C.A.T. scan, C.A.T. discogram) demonstrating mechanical pressure on the spinal nerve from disc herniation or bone spur. (lumbar disc herniation, some selected cases of spinal stenosis) Technical Considerations Through a MicroEndoscopic portal different anatomic regions can be accessed: lamina, medial facet, lateral facet, foraminal entrance, foraminal exit, the spinal nerve, and the disc. Literature Review Featured Review: Microendoscopic discectomy allows the surgeon intra-spinal (inside the spinal canal) and extra-spinal access (outside the spinal canal) for the herniated disc (ref #2, ref #3, ref #4, ref #5). The results of surgery for microendcopic surgery are excellent (ref #1) and the technical aspects of the procedure have been clearly defined (ref#5). The entire field of minimally invasive surgery applied to the lumbar herniated disc has been recently summarized and the progress documented (ref #1).Complications Return to Menu The complications of lumbar microendoscopic surgery are death, paralysis, failure to improve, instatiblity, nerve root injury, spinal fluid leak, wound problems, infections, etc. Author’s Comment The standard bearer of minimally invasive lumbar disc surgery is the M.E.D. (microendoscopic discectomy, also named METrx). The revolution in endoscopic surgical instruments and surgical cameras has allowed rapid advances in minimally invasive spine surgery. Most patients seem to prefer the outpatient M.E.D. to the more traditional operations when offered the choice. References 1. Yeung, A.T., The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med, 2000. 67(4): p. 327-32. 2. Foley, K.S.M., Microendosocpic Approach to Far-Lateral Lumbar Disc Herniation. Neurosurgical Focus, 1999. 7(5): p. Article 5. 3. Dirksmeier, P.P., IM Kang, JD, Microendoscopic and Open Laminotomy and Discectomy in Lumbar Disc Disease. Seminars in Spine Surgery, 1999. 11(2): p. 138-146. 4. Rapp, S., New Endosocopic Lumbar Technique Improves Access, Preserves Tissue. Othopaedics Today, 1998. 18(1). 5. Foley, K.S.M., Microendoscopic Discectomy. Techniques in Neurosurgery, 1997. 3(4): p. 301-307. |