In the past, the cervical and thoracic vertebrae were areas that were not well performed by spinal endoscopy. However, with the rapid development of spinal endoscopic surgery techniques and instruments, various kinds of spinal endoscopic approaches are currently performing and developing in the cervical and thoracic spine. This is the first book covering the latest knowledge of cervical and thoracic spinal endoscopic surgery.
This book will provide abundant illustrations and also surgical videos so that it can be easily understood by spinal surgeons who are learning and studying spinal endoscopy. In addition, the prevention of complications associated with endoscopic surgery will be discussed in detail.
Author(s): Hyeun Sung Kim, Dong Hwa Heo, Kangtaek Lim, Cheol Woong Park, Chun-Kun Park
Publisher: Springer
Year: 2023
Language: English
Pages: 228
City: Singapore
Preface by Chun-Kun Park
Preface by Cheol Woong Park
Preface by Dong Hwa Heo
Preface by Hyeun Sung Kim
Preface by Kangtaek Lim
Acknowledgment
Contents
Part I: Cervical - Introduction
Anatomical Consideration of Posterior Cervical Endoscopic Approaches
1 Radiological Anatomy for Cervical Endoscopic Posterior Approach
1.1 Simple X-Ray and C-Arm Fluoroscopic Anatomy
1.2 Computed Tomography Anatomy
1.3 Magnetic Resonance Imaging Anatomy
2 Endoscopic Anatomy
2.1 Bony Surface Anatomy
2.2 Cervical Ligamentum Flavum
2.3 Peridural Membrane
2.4 Cervical Dura and Nerve Root
2.5 Axillar and Pedicle Area
3 Conclusion
References
Prevention of Complications
1 Introduction
1.1 Cervical Endoscopic Decompression and Discectomy
1.2 Anatomical Landmarks
1.3 Learning Curve
2 Anterior Endoscopic Cervical Discectomy
2.1 Anatomical Consideration before AECD
2.2 Prevention of Disc Height Reduction
2.3 AECD-Specific Instruments Are Required
3 Posterior Endoscopic Cervical Foraminotomy and Discectomy
3.1 Incomplete Decompression
3.2 Dural Injury
3.3 Postoperative Dysesthesia and Injuries to Nerve Roots or the Spinal Cord
3.4 Hematoma
3.5 Persistent Neck Pain and Surgically Induced Instability
4 How to Avoid Complications in Endoscopic Spine Surgery
5 Conclusion
References
Part II: Cervical - Uniportal
Uniportal Cervical Posterior Foraminotomy and Discectomy
1 Advantages of this Approach
2 Indications and Contraindications
3 Anesthesia and Position
4 Special Instruments (Fig. 2)
5 Procedures
5.1 Preoperative Targeting By Needle and Skin Incision
5.2 Sequential Dilation and Working Cannula Insertion (Fig. 4)
5.3 Confirmation of Anatomical Landmark (V Point) (Fig. 5)
5.4 Circumferential Decompression
5.5 The Removal of a Lateral Part of LF, Soft-Tissue Dissection, and Adhesiolysis Around the Exiting Root
5.6 Additional Decompression (Discectomy, Foraminotomy, or Pediculotomy) and Confirmation of the Decompressed Exiting Root
5.7 Hemostasis and Closure
6 Illustrated Cases
6.1 Case 1: Paracentral Disc Herniation
6.2 Case 2: Foraminal Stenosis
6.3 Case 3: Bilevel Foraminal Decompression
7 Prevention and Management of Complications
8 Discussion (Surgical Tips and Pitfalls)
References
Cervical Multilevel Foraminotomy Using Single Incision
1 Advantages of this Approach (Introduction)
2 Indications and Contraindications
3 Anesthesia and Position
4 Special Instrument
5 Procedures
6 Illustrated Cases
7 Prevention and Management of Complications
8 Discussion
References
Posterior Full Endoscopic Cervical Foraminotomy and Discectomy Using the Partial Pediculotomy and Partial Vertebrectomy
1 Advantages of This Approach
1.1 Advantages
2 Indications and Contraindications
2.1 Clinical Indications
2.2 Radiological Indications
2.3 Contraindications
2.4 Relative Contraindications
3 Anesthesia and Position
4 Special Instruments (Fig. 2)
5 Procedures
5.1 Anatomical Consideration
5.2 Step 1. Entry Point Marking
5.3 Step 2. Approach and Docking
5.4 Step 3. Bony Decompression with Foraminotomy (Video 1)
5.5 Step 4. Complete Exiting Nerve Root Decompression with Vertebrectomy (Video 1)
6 Illustrated Cases
6.1 Case 1 (Fig. 12)
6.2 Case 2 (Fig. 13)
7 Prevention and Management of Complications
7.1 Instability (Fig. 14)
7.2 C5 Nerve Palsy (Fig. 15)
7.3 Spinal Cord Injury (Fig. 16)
8 Discussion (Surgical Tips and Pitfall)
References
Uniportal Full Endoscopic Posterior Cervical Decompressive Laminectomy
1 Advantages of the Uniportal Endoscopic Approach for Posterior Cervical Decompressive Laminectomy
2 Indications and Contraindications
3 Anesthesia and Position
4 Special Instruments
5 Surgical Steps of the Uniportal Endoscopic Posterior Cervical Approach for Bilateral Canal Stenosis
5.1 Making the Skin Entry and Inserting the Working Cannula
5.2 Soft Tissue Dissection to Expose the Targeted Lamina and Interlaminar Window (Video 1)
5.3 Partial Laminotomy Along the Caudal Border of the Upper-Level Lamina (Video 2)
5.4 Partial Laminotomy Along the Cranial Border of the Lower-Level Lamina (Video 3)
5.5 Detachment and Removing of Hypertrophied Ligamentum Flavum (Video 4)
5.6 Essential Surgical Steps to Access the Contralateral Area
6 Surgical Steps for Combined Pathologies of the Cervical Canal and Foraminal Stenosis (Videos 5 and 6)
7 Left Uniportal Endoscopic Posterior Cervical Approach for ULBD at the C5–6 Level (Video 5)
8 Left Uniportal Endoscopic Posterior Cervical Approach for Unilateral Canal Decompression and Foraminotomy at the C6–7 Level
8.1 Ipsilateral Laminotomy to Free the Hypertrophied Ligamentum Flavum (Video 6)
8.2 Foraminotomy to Remove the Bony Spur and Herniated Disc (Video 6)
8.3 Removal of the Hypertrophied Ligamentum Flavum (Video 6)
8.4 Extent of Bony Removal
9 Illustrated Cases
10 Prevention and Management of Complications (Videos 7 and 8)
11 Discussion (Surgical Tips and Pitfalls)
References
Full Endoscopic Anterior Cervical Discectomy and Fusion (ACDF) and Arthroplasty
1 Advantages of this Approach (Introduction)
2 Indications and Contraindications
3 Anesthesia and Position
4 Special Instrument
5 Procedures (Video 1)
6 Illustrated Cases
7 Prevention and Management of Complications
8 Discussion
References
Part III: Cervical - Biportal
Biportal Endoscopic Posterior Cervical Foraminotomy and Discectomy
1 Introduction
2 Indications and Contraindications
2.1 Indications
2.2 Contraindications
3 Anesthesia and Positioning
4 Special Instrument
5 Surgical Steps of Posterior Cervical Foraminotomy by Biportal Endoscopy (Video 1)
5.1 Making Two Portals
5.2 Bone Work
5.3 Decompression and Exposure of Dura and Nerve Root
5.4 Discectomy
5.5 End of Operation
6 Illustrated Cases
7 Prevention and Management of Complications
8 Discussion (Surgical Tips and Pitfalls)
References
Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy and Discectomy
1 Introduction
2 Indications and Contraindications
3 Special Instruments
4 Anesthesia and Position
5 Surgical Steps of Biportal Endoscopic PCIF
6 Illustrated Cases
6.1 Case 1: Biportal Endoscopic PCIF on the Right Side of the C5-6 and C6-7 Levels
6.2 Case 2: Biportal Endoscopic PCIF on the Left Side of the C5-6 Level
7 Prevention and Management of Complications
7.1 Bleeding
7.2 Dural Tear
7.3 Nerve Root Retraction Injury
7.4 Insufficient Neural Decompression
8 Surgical Tips and Pitfalls
References
Cervical Laminectomy via Interspinous Approach by Unilateral Biportal Endoscopy
1 Advantages of this Approach
2 Indications and Contraindications
3 Anesthesia and Position
4 Special Instruments
5 Procedures
5.1 The Concept of Cervical Laminectomy by UBE
5.2 Skin Marking and Establishment of Portals
5.3 Initial Working Space and Bone Working (Video 1)
5.4 Removal of LF (Video 2)
5.5 Foraminotomy
5.6 Two-Level Surgical Technique
5.7 Postoperative Drain
5.8 Postoperative Care
5.9 Illustrated Cases
5.9.1 Case 1: Cervical Spondylosis on the C6–C7 Levels
5.9.2 Case 2: Cervical Spondylosis on the C4–C5, C5–C6, and C6–C7 Levels
5.9.3 Case 3: OPLL at the C4–C5 Levels
6 Prevention and Management of Complications
6.1 Cord Injury
6.2 Dural Tear
6.3 Postoperative Hematoma
7 Discussion (Surgical Tips and Pitfall)
References
Endoscopic Assistant Cervical Instrumentation
1 Introduction
2 Surgical Anatomy (Fig. 1)
3 Position (Fig. 2)
4 Surgical Instruments (Fig. 3)
5 Surgical Procedure
5.1 Step 1. Skin Mark, Incision, and Biportal Making (Fig. 4)
5.2 Step 2. Determination of the Entry Point and Placing the Screw
6 Pitfall
References
Part IV: Thoracic - Introduction
Anatomical Considerations for Thoracic Endoscopic Spine Surgery
1 Transforaminal Approach
1.1 Identifying the Surgical Level
1.2 Intervertebral Neural Foramen
1.3 Spinal Canal
1.4 Endoscopic Anatomy of Transforaminal Approach
2 Posterior Approach
2.1 Radiological Anatomy
2.2 Endoscopic Anatomy of Posterior Thoracic Approaches
References
Part V: Thoracic - Uniportal
Transforaminal Thoracic Discectomy
1 Introduction
2 Indications
3 Anesthesia and Position
4 Special Instrument
5 Procedures
6 Illustrated Cases
6.1 Case 1
6.2 Case 2
7 Prevention and Management of Complications
8 Discussion
References
Thoracic Full Endoscopic Unilateral Laminotomy with Bilateral Decompression (TE ULBD)
1 Introduction
1.1 Advantages
1.2 Disadvantages
2 Clinical Indications
3 Radiographic Indications
4 Radiographic Relative Contraindications
5 Contraindications
6 Anatomical Considerations
7 Preoperative Surgical Planning
8 Anesthesia and Positioning
9 Thoracic Endoscopic Equipment
10 Surgical Steps
10.1 Step 1: Entry Point Marking
10.1.1 Identification of the Surgical Level and Safe Docking of the Endoscope
10.2 Step 2: Approach and Docking
10.3 Step 3: Soft-Tissue Dissection
10.4 Step 4: Bony Decompression
10.5 Step 5: Ligamentum Flavum Decompression
10.6 Step 6: Final Assessment of Adequacy of Decompression and Status of Neural Elements Prior to Skin Closure
11 Complications
12 Postoperative Care
13 Discussion: Surgical Tips and Pitfalls
14 Conclusions
References
Part VI: Thoracic - Biportal
Thoracic Decompressive Laminectomy by Unilateral Biportal Endoscopy
1 Advantages of the Biportal Endoscopic Approach for Thoracic Decompressive Laminectomy
2 Indications and Contraindications
2.1 Indication
2.2 Relative Contraindications
2.3 Contraindications
3 Anesthesia and Position
4 Special Instruments
5 Surgical Steps of the Biportal Endoscopic Posterior Approach for Bilateral OLF
5.1 Making of Two Portals
5.2 Bilateral Cortical Bone Drilling Overlying the OLF (Videos 1 and 2)
5.3 Layer-by-Layer Thinning and Cutting of the Bilateral Lamina (Videos 3 and 4)
5.4 Floating and Removal of the OLF (Video 5)
6 Surgical Steps of the Biportal Endoscopic Posterior Approach for Unilateral OLF (Video 6)
7 Illustrated Cases
8 Prevention and Management of Complications
9 Discussion (Surgical Tips and Pitfalls)
References
Posterolateral Approach for Thoracic Disc Herniation by Unilateral Biportal Endoscopy
1 Advantages of this Approach (Introduction)
2 Indications and Contraindications
3 Anesthesia and Position
4 Special Instruments
5 Procedures (Surgical Steps, Videos 1 and 2)
5.1 Concept of Posterolateral Approach for TDH by UBE
5.2 Skin Marking and Making Portal
5.3 Bone Working
5.4 Discectomy
5.5 Postoperative Drain
5.6 Postoperative Care
6 Illustrated Cases
6.1 Case 1: TDH at the T11–T12 Level with Upward Migration
6.2 Case 2: Myelopathy Due to a TDH at the T8–T9 Level
7 Prevention and Management of Complications
7.1 Dural Tear
7.2 Cord Injury
8 Discussion (Surgical Tips and Pitfalls)
References
