Transcript Trans-Thoracic Discectomy

Endoscopic Spinal Surgery
Aprajay Golash
Consultant Neurosurgeon
Royal Preston Hospital, UK
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
[email protected] for details.
Let’s see a case!
55yr, Female
Spastic paraparesis for 6 months, getting
worse
Options for access
Thoracotomy
Thoracoscopic (Video assisted)
Mini- thoracotomy
Posterior approaches
Approach I chose
Thoracoscopic Discectomy- because it
retains the advantages of thoracotomy for
exposure but avoids high morbidity
Clinical outcome
Good neurological recovery
Less post operative pain
Early mobilisation
Intra operative CSF leak
Post Operative scans
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!)
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.
Cervical Endoscopic foraminotomy
Percuteneous access with serial
dialatation
Endoscopic magnified (but 2-D !)
visualisation.
Minimal injury to muscles
Same results as open foraminotomy.
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
Cervical Endoscopic foraminotomy
Benefits- (over open procedure)
– Minimal muscle trauma
– Decreased hospital stay
Disadvantages– Steep learning curve
– Separate approach required for bilateral
procedure
Cervical Endoscopic discectomy
Anterior percuteneous approach under xray control
Mainly for soft disc
C3-C7
Better approached from contralaterl side
May be done as day case
Avoids fusion
Thoracoscopic spinal surgery
Herniated disc (even large calcified!)
Spinal fractures
Anterior release for scoliosis
Biopsy for tumour or infection
Endoscopic Lumbar surgery
Approaches– Interlaminar
– Posterolateral
– Far lateral or extreme
– Anterior retroperitoneal
– Anterior trans peritoneal
Endoscopic Lumbar surgery
Indications– Disc herniation
– Degenerative disc disease
– Spinal stenosis
– Infection
– Tumour
Endoscopic Lumbar surgery
Disadvantages– Difficult for migrated disc
– Long learning curve
– Access to L5/S1 may be difficult
– Difficult with previous spinal surgery
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.
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.