Endoscopic Spinal Surgery

1
Endoscopic Spinal Surgery

• Aprajay Golash
• Consultant Neurosurgeon
• Royal Preston Hospital, UK

2

• In this presentation I am trying to give a
  flavour of current spinal endoscopic surgery and
  hopefully raise some interest in this evolving
  field.
• I am making no attempt to give details of any
  techinques but would be very happy to be
  contacted on aprajay.golash_at_lthtr.nhs.uk for
  details.

3
Lets see a case!

• 55yr, Female
• Spastic paraparesis for 6 months, getting worse

4
Options for access

• Thoracotomy
• Thoracoscopic (Video assisted)
• Mini- thoracotomy
• Posterior approaches

5
Approach I chose

• Thoracoscopic Discectomy- because it retains the
  advantages of thoracotomy for exposure but avoids
  high morbidity

6
Clinical outcome

• Good neurological recovery
• Less post operative pain
• Early mobilisation
• Intra operative CSF leak

7
Post Operative scans
8
(No Transcript)
9
Endoscopic Spinal Surgery

• This is a developing and sometimes controversial
  field.
• While developing, patient safety must be
  maintained.
• Outcome compared with Gold standard (there are
  no agreed gold standards for many conditions!)

10
Why endoscopic surgery?

• Less damage to normal structure
• Less blood loss
• Quick recovery
• Less post operative pain
• Easier approach in Obese patients!
• May be done under local anaesthetic sedation.

11
Cervical Endoscopic foraminotomy

• Percuteneous access with serial dialatation
• Endoscopic magnified (but 2-D !) visualisation.
• Minimal injury to muscles
• Same results as open foraminotomy.

12
Cervical Endoscopic foraminotomy

• Indications-
• Ideally for soft disc herniation but can be used
  for hard disc.
• Lateral recess or foraminal stenosis
• Contra indications-
• Large central disc or stenosis
• Instability or severe kyphosis

13
Cervical Endoscopic foraminotomy

• Benefits- (over open procedure)
• Minimal muscle trauma
• Decreased hospital stay
• Disadvantages-
• Steep learning curve
• Separate approach required for bilateral procedure

14
Cervical Endoscopic discectomy

• Anterior percuteneous approach under x-ray
  control
• Mainly for soft disc
• C3-C7
• Better approached from contralaterl side
• May be done as day case
• Avoids fusion

15
Thoracoscopic spinal surgery

• Herniated disc (even large calcified!)
• Spinal fractures
• Anterior release for scoliosis
• Biopsy for tumour or infection

16
Endoscopic Lumbar surgery

• Approaches-
• Interlaminar
• Posterolateral
• Far lateral or extreme
• Anterior retroperitoneal
• Anterior trans peritoneal

17
Endoscopic Lumbar surgery

• Indications-
• Disc herniation
• Degenerative disc disease
• Spinal stenosis
• Infection
• Tumour

18
Endoscopic Lumbar surgery

• Disadvantages-
• Difficult for migrated disc
• Long learning curve
• Access to L5/S1 may be difficult
• Difficult with previous spinal surgery

19
Further Developments

• Images Guided endoscopic spinal surgery
• 3-D endoscopes
• Intra dural endoscopic procedures

I was planning to put some video clips in this
presentation but I found many good ones in You
tube! Though this is not an alternative to visit
some experienced surgeons but is good enough to
get a flavour.
20
Caution!

• Patient safety must be maintained while learning
  curve is achieved.
• Patient selection is critical.
• No harm in using traditional approach if in any
  difficulty.

21
(No Transcript)