Abstract
Degenerative “infringements” of the spinal canal with compression of neural elements arise as a result of bony, disk, capsular, or ligament structures. The most frequent causes are disk herniations and spinal stenosis. After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region. It is associated with good clinical results, but presents technique-associated problems. Spine decompression operations must be carried out under continuous visualization and must consider the extent of bone resection. Taking this into account, new endoscopes and instrument sets were developed for endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches. The results of comparable established standard procedures were used as a benchmark in the course of clinical validation. The development of new surgical approaches and the advent of the rod-lens endoscope, combined with commensurate instrument sets, have provided the technical foundations for an endoscopic lumbar spine operation for all primary and recurrent disk herniations inside and outside the spinal canal and for spinal stenosis. The clinical results of standard procedures are relatively well known. This must be regarded as a minimal criterion for the introduction of new technologies. On evidence-based medicine (EBM) criteria, it can be established that using full-endoscopic techniques, adequate decompression can be achieved with minimal surgically induced trauma, improved visibility, and positive cost-benefits. Today, full-endoscopic operations may be regarded as an expansion and alternative means to accomplish surgical decompression.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:205–10.
Putti V. Pathogenesis of sciatic pain. Lancet. 1927;2:53.
Steinke CR. Spinal tumors: statistics on a series of 330 collected cases. J Nerv Ment Dis. 1918;47:418–26.
Stookey B. Compression of spinal cord due to ventral extradural chondromas: diagnosis and surgical treatment. Arch Neurol Psychiatry. 1928;20:275–91.
Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–8.
Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damaging through a microsurgical approach. Adv Neurosurg. 1977;7:74–7. In: Wüllenweber R, Brock M, editors.
Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Res. 1999;21:39–42.
Forst R, Hausmann G. Nucleoscopy: a new examination technique. Arch Orthop Trauma Surg. 1983;101:219–21.
Goald HJ. Microlumbar discectomy – follow-up of 147 patients. Spine. 1978;3:183–5.
Hijikata S. Percutaneous discectomy: a new treatment method for lumbar disc herniation. J Toden Hosp. 1975;5:5–13.
Hult L. Retroperitoneal disc fenestration in low back pain and sciata. Acta Orthop Scand. 1956;20:342–8.
Maroon JC, Onik G, Sternau L. Percutaneous automated discectomy: a new approach to lumbar surgery. Clin Orthop. 1989;238:64–70.
Wilson DH, Kenning J. Microsurgical lumbar discectomy: preliminary report of 83 consecutive cases. Neurosurgery. 1979;42:137–40.
Valls J, Ottolenghi CE, Schajowicz F. Aspiration biopsy in diagnosis of lesions of vertebral bodies. JAMA. 1948;136:376.
Gottlob C, Kopchok G, Peng SH, Tabbara M, Cavaye D, White RA. Holmium:YAG laser ablation of human intervertebral disc: preliminary evaluation. Lasers Surg Med. 1992;12:86–91.
Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine: a preliminary report. Clin Orthop. 1983;174:127–32.
Smith L, Garvin PJ, Gesler RM, Jennings RB. Enzyme dissolution of the annulus pulposus. Nature. 1963;198:1311–2.
Kambin P, Casey K, O’Brien E, Zhou L. Transforaminal arthroscopic decompression of the lateral recess stenosis. J Neurosurg. 1996;84:462–7.
Lew SM, Mehalic TF, Fagone KL. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg. 2001;94:216–20.
Mathews HH. Transforaminal endoscopic microdiscectomy. Neurosurg Clin N Am. 1996;7:59–63.
Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg. 1993;78:261.
Savitz MH. Same-day microsurgical arthroscopic lateral-approach laser-assisted (SMALL) fluoroscopic discectomy. J Neurosurg. 1994;80:1039–45.
Brayda-Bruno M, Cinnella P. Posterior endoscopic discectomy (and other procedures). Eur Spine J. 2000;9:24–9.
Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci. 2003;10:231–5.
Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM. Microendoscopic lumbar discectomy: technical note. Neurosurgery. 2002;51:129–36.
Schick U, Doehnert J, Richter A, Konig A, Vitzkun HE. Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine. 2002;11:20–6.
Jang JS, An SH, Lee SH. Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech. 2006;19:338–43.
Kambin P, O’Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop. 1998;347:150–67.
Stuecker R. The transforaminal endoscopic approach. In: Mayer HM, editor. Minimally invasive spine surgery. Berlin: Springer; 2000. p. 201–6.
Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine. 2006;31:285–90.
Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disc herniation. Oper Orthop Traumatol. 2005;17:641–61.
Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach. – Technique and prospective results of 463 patients. Spine. 2005;30:2570–8.
Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6:521–30.
Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33:931–9.
Ruetten S. The full-endoscopic interlaminar approach for lumbar disc herniations. In: Mayer HM, editor. Minimally invasive spine surgery. Berlin: Springer; 2005. p. 346–55.
Ruetten S, Komp M, Godolias G. A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6 mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg. 2006;49:80–7.
Andersson GBJ, Brown MD, Dvorak J, Herzog RJ, Kambin P, Malter A, et al. Consensus summary on the diagnosis and treatment of lumbar disc herniation. Spine. 1996;21:75–8.
McCulloch JA. Focus issue on lumbar disc herniation: macro- and microdiscectomy. Spine. 1996;21:45–56.
Maroon JC. Current concepts in minimally invasive discectomy. Neurosurgery. 2002;51:137–45.
Komp M, Hahn P, Merk H, Godolias G, Ruetten S. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech. 2011;24:281–7.
Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar and transforaminal approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine. 2009;10:476–85.
Ruetten S, Komp M, Merk H, Godolias G. Recurrent lumbar disc herniation following conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech. 2009;22:122–9.
Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Criso JJ. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 1990;15:1142–7.
Cooper R, Mitchell W, Illingworth K, Forbes WS, Gillespie JE, Jayson MI. The role of epidural fibrosis and defective fibrinolysis in the persistence of postlaminectomy back pain. Spine. 1991;16:1044–8.
Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome: reasons, intraoperative findings and long term results: a report of 182 operative treatments. Spine. 1996;21:626–33.
Haher TR, O’Brien M, Dryer JW, Nucci R, Zipnick R, Leone DJ. The role of the lumbar facet joints in spinal stability. Identification of alternative paths of loading. Spine. 1994;19:2667–70.
Hopp E, Tsou PM. Postdecompression lumbar instability. Clin Orthop. 1988;227:143–51.
Kaigle AM, Holm SH, Hansson TH. Experimental instability in the lumbar spine. Spine. 1995;20:421–30.
Kato Y, Panjabi MM, Nibu K. Biomechanical study of lumbar spinal stability after osteoplastic laminectomy. J Spinal Disord. 1998;11:146–50.
Kotilainen E, Valtonen S. Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir. 1993;125:120–6.
Ruetten S, Meyer O, Godolias G. Endoscopic surgery of the lumbar epidural space (epiduroscopy): results of therapeutic intervention from 93 patients. Minim Invasive Neurosurg. 2003;46:1–4.
Schoeggl A, Maier H, Saringer W, Reddy M, Matula C. Outcome after chronic sciatica as the only reason for lumbar microdiscectomy. J Spinal Disord Tech. 2002;15:415–9.
Sharma M, Langrana NA, Rodrigues J. Role of ligaments and facets in lumbar spinal stability. Spine. 1995;20:887–900.
Mayer HM. The microsurgical interlaminar, paramedian approach. In: Mayer HM, editor. Minimally invasive spine surgery. Berlin: Springer; 2000. p. 79–91.
Ramirez LF, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals. Neurosurgery. 1989;25:226–31.
Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lekto M. The lumbar multifidus muscle five year after surgery for a lumbar intervertebral disc herniation. Spine. 1993;18:568–74.
Stolke D, Sollmann WP, Seifert V. Intra- and postoperative complications in lumbar disc surgery. Spine. 1989;14:56–9.
Wildfoerster U. Intraoperative complications in lumbar intervertebral disc operations. Cooperative study of the spinal study group of the German Society of Neurosurgery. Neurochirurgica. 1991;34:53–6.
Aydin Y, Ziyal IM, Dumam H, Turkmen CS, Basak M, Sakin Y. Clinical and radiological results of lumbar microdiscectomy technique with preserving of ligamentum flavum comparing to the standard microdiscectomy technique. Surg Neurol. 2002;57:5–13.
De Devitiis E, Cappabianca P. Lumbar discectomy with preservation of the ligamentum flavum. Surg Neurol. 2002;58:68–9.
Ebara S, Harada T, Hosono N, Yonenobu K, Hiroshima K, Ono K. Intraoperative measurement of lumbar spinal instability. Spine. 1992;17:44–50.
Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir. 1995;133:107–11.
Goel VK, Nishiyama K, Weinstein JN, Lin YK. Mechanical properties of lumbar spinal motion segments as affected by partial disc removal. Spine. 1986;11:1008–12.
Iida Y, Kataoka O, Sho T, Sumi M, Hirose T, Bessko Y, et al. Postoperative lumbar spinal instability occurring or progressing secondary to laminectomy. Spine. 1990;15:1186–9.
Johnsson KE, Redlund-Johnell I, Uden A, Willner S. Preoperative and postoperative instability in lumbar spinal stenosis. Spine. 1989;14:591–3.
Mochida J, Toh E, Nomura T. The risks and benefits of percutaneous nucleotomy for lumbar disc herniation. A 10-year longitudinal study. J Bone Joint Surg Br. 2001;83:501–5.
Zander T, Rohlmann A, Kloeckner C, Bergmann G. Influence of graded facetectomy and laminectomy on spinal biomechanics. Eur Spine J. 2003;12:427–34.
Zollner J, Rosendahl T, Herbsthofer B, Humke T, Eysel P. The effect of various nucleotomy techniques on biomechanical properties of the intervertebral disc. Z Orthop. 1999;137:206–10.
Donceel P, Du Bois M. Fitness for work after lumbar disc herniation: a retrospective study. Eur Spine. 1998;7:29–35.
Boyer P, Srour R, Buchheit F, Krause D, Albuquerque M. Lumbar disc hernia. Excision of hernia with or without complementary discectomy? Neurochirurgie. 1994;40:259–62.
Carragee EJ, Spinnikie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine. 2006;31:653–7.
Hirabayashi S, Kumano K, Ogawa Y, Aota Y, Machiro S. Microdiscectomy and second operation for lumbar disc herniation. Spine. 1993;18:2206–11.
Stambough JL. Lumbar disk herniation: an analysis of 175 surgically treated cases. J Spinal Disord. 1997;10:488–92.
Wenger M, Mariani L, Kalbarczyk A, Groger U. Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery. 2001;49:329–34.
Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K. Long-term outcomes of standard discectomy for lumbar disc herniation. Spine. 2001;26:652–7.
Kim SS, Michelsen CB. Revision surgery for failed back surgery syndrome. Spine. 1992;17:957–60.
Law JD, Lehman RAW, Kirsch WM. Reoperation after lumbar intervertebral disc surgery. J Neurosurg. 1978;94:259–63.
Waddell G, Reilly S, Torsney B, Allan DB, Morris EW, Di Paola MP. Assessment of the outcome of low back surgery. J Bone Jt Surg Br. 1988;70:723–7.
Connolly ES. Surgery for recurrent lumbar disc herniation. Clin Neurosurg. 1992;39:211–6.
Ebeling U, Kalbarcyk H, Reulen HJ. Microsurgical reoperation following lumbar disc surgery. Timing, surgical findings, and outcome in 92 patients. J Neurosurg. 1989;70:397–404.
Fandino J, Botana C, Viladrich A, et al. Reoperation after lumbar disc surgery: results in 130 cases. Acta Neurochir Wien. 1993;122:102–4.
Jonsson B, Stromqvist B. Repeat decompression of lumbar nerve roots: a prospective two-year evaluation. J Bone J Surg Br. 1993;75:894–7.
Hall S, Bartleson JD, Onofrio BM, et al. Lumbar spinal stenosis: clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med. 1985;103:271–5.
LaRocca H, MacNab I. The laminectomy membrane. Studies in its evaluation, characteristics, effects and prophylaxis in dogs. J Bone J Surg Br. 1974;56:545–50.
Markwalder TM. Surgical management of neurogenic claudication in 100 patients with lumbar spinal stenosis due to degenerative spondylolisthesis. Acta Neurochir. 1993;120:136–42.
Ragab AA, Fye MA, Bohlmann HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine. 2003;28:348–53.
Lewis PJ, Weir BKA, Broad RW, Grace MG. Long-term prospective study of lumbosacral discectomy. J Neurosurg. 1987;67:49–54.
Ahn Y, Lee SH, Shin SW. Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg. 2005;23:362–8.
Isaacs RE, Podichetty V, Fessler RG. Microendoscopic discectomy for recurrent disc herniations. Neurosurg Focus. 2003;15:E11.
Caspar W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y. The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery. 1991;28:78–87.
Wilson DH, Harbaugh R. Lumbar discectomy: a comparative study of microsurgical and standard technique. In: Hardy RW, editor. Lumbar disc disease. New York: Racen Press; 1982. p. 147–56.
Annertz M, Jonsson B, Stromqvist B, Holtas S. No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients. Spine. 1995;20:449–53.
Kotilainen E. Percutaneous nucleotomy in the treatment of cervical disc herniation: report of three cases and review. Minim Invasive Neurosurg. 1999;42:152–5.
Kotilainen E. Clinical instability of the lumbar spine after microdiscectomy. In: Gerber BE, Knight M, Siebert WE, editors. Lasers in the musculoskeletal system. Berlin: Springer; 2001. p. 241–3.
Frank EH, Hsu FP. An endoscopic dural retractor for spinal stenosis surgery. Minim Invasive Neurosurg. 2002;45:136–8.
Getty CJM, Johnson JR, Kirwan E, O’Sullivan MF. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone J Surg Br. 1981;63:330–5.
Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine. 2002;27:432–8.
Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002;51:146–54.
Mayer HM, List J, Korge A, Wiechert K. Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach. Orthopaede. 2003;32:889–95.
Sanderson PL, Getty CJM. Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine. 1996;21:1352–6.
Young S, Veerapen R, O’Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestration as an alternative to wide laminectomy: a preliminary report. Neurosurgery. 1988;23:628–33.
Ruetten S, Komp M, Merk H, Godolias G. A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invas Neurosurg. 2007;50:219–26.
Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine. 2008;33:940–8.
Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop Int Orthop. 2008. doi:10.1007/s00264-008-0684-y.
Tajima T, Sakamoto H, Yamakawa H. Diskectomy cervicale percutanee. Rev Med Orthop. 1989;17:7–10.
Zhou YC, Zhou YQ, Wang CY. Percutaneous cervical discectomy for treating cervical disc herniation – a report of 12 cases. J Tongji Med Univ. 1994;14:110–3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Ruetten, S., Komp, M., Oezdemir, S., Hahn, P. (2016). Endoscopic Procedures for the Lumbar Spine: A Comprehensive View. In: Pinheiro-Franco, J., Vaccaro, A., Benzel, E., Mayer, H. (eds) Advanced Concepts in Lumbar Degenerative Disk Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47756-4_34
Download citation
DOI: https://doi.org/10.1007/978-3-662-47756-4_34
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-47755-7
Online ISBN: 978-3-662-47756-4
eBook Packages: MedicineMedicine (R0)