Endoscopy of the Spine: Principle and Practice

Foreword
Foreword
Preface
Acknowledgement
Contents
Part I: Basic Knowledge
1: Practical and Applied Anatomy for Full Endoscopic Spine Surgery
1.1 Introduction
1.1.1 Overview of Spine Anatomy
1.1.2 Adult Spine Anatomy
1.1.3 Surgical Landmarks
1.1.4 Blood Supply
1.1.5 Spinal Nerve
1.2 Cervical Spine Anatomy
1.2.1 C1 (Atlas)
1.2.2 C2 (Axis)
1.2.3 Foramina Transversaria
1.2.4 C3-C7 (Subaxial Cervical Spine)
1.2.5 Cervical Disc
1.2.6 Cervical Spinal Nerve Roots
1.2.7 Role of the Cervical Nerve
1.2.8 Cervical Spine Blood Supply
1.2.9 Anterior Cervical Spine Anatomy
1.2.10 Application of Anterior Full Endoscopic Cervical Discectomy
1.2.11 Posterior Cervical Spine Anatomy
1.2.12 Posterior Fascia
1.2.13 Ligamentum Nuchae
1.2.14 Muscles of the Posterior Cervical Spine
1.2.15 Ligamentum Flavum
1.2.16 Interlaminar Area of Posterior Cervical Spine
1.2.17 Application of Posterior Full Endoscopic Cervical Discectomy/Laminoforaminotomy
1.3 Thoracic Spine Anatomy
1.3.1 Specific Characteristic Features
1.3.2 Thoracic Discs
1.3.3 Role of the Thoracic Nerve
1.3.4 Ligaments
1.3.5 Relevant Anatomy
1.3.6 Posterior Thoracic Spine Anatomy
1.3.7 Application of Posterior Full Endoscopic Thoracic Discectomy
1.4 Lumbar Spine Anatomy
1.4.1 Venous Supply
1.4.1.1 External Venous Plexus
1.4.1.2 Internal Venous Plexus
1.4.2 Arterial Supply
1.4.3 Lumbar Anatomy Base on Columns Concepts
1.4.4 Lumbar Disc
1.4.4.1 Lumbar Nerve Root and Branches
1.4.4.2 Dorsal Root Ganglia of Lumbar Spine
1.4.4.3 Lumbar Nerve Root Various Types and Anomalies
1.4.4.4 Pedicle Morphology
1.4.4.5 Neural Foramen
1.4.4.6 Surface Anatomy
1.4.4.7 Zone of the Lumbar Disc Herniation
1.4.4.8 Level of Migrated Disc Herniation
1.4.4.9 Interlaminar Space
1.4.4.10 Ligament Flava
1.4.4.11 Interlaminar Window and Width
1.4.4.12 Kambin’s Triangle
1.5 Summary
References
2: Role of Radiological Investigations in Diagnosis of Spinal Disorders and Surgical Planning of Endoscopic Spine Surgery
2.1 Introduction
2.2 Role of Radiology in Diagnosis of Spinal Disorders
2.2.1 Overview of Imaging Modalities
2.2.1.1 Radiographs
2.2.1.2 Fluoroscopy and Cone-Beam CT
2.2.1.3 Computed Tomography (CT) and Dual-Energy CT (DECT)
2.2.1.4 Magnetic Resonance Imaging (MRI)
2.2.1.5 Nuclear Medicine (NM)
2.2.1.6 Ultrasound (US)
2.3 Role of Radiology in Surgical Planning
2.3.1 General Status of the Spine
2.3.2 Vertebral Level Labeling
2.3.3 Congenital/Acquired Vertebral Defects
2.3.4 Spinal Canal, Cord/Cauda Equina Status
2.3.5 Types of Stenotic Pathology and Impact on Endoscopic Approach
2.3.6 Transforaminal Corridor Considerations
2.3.7 Interlaminar Corridor Considerations
2.3.8 Oblique and Lateral Corridor Considerations
2.4 Role of Radiology in Postsurgical Evaluation
2.4.1 Expected Postoperative Appearances
2.4.2 Spinal Implants and Related Complications
2.4.3 Nonimplant Complications: Early
2.4.4 Nonimplant Complications: Late
2.5 Summary
References
3: Instruments in Endoscopic Spinal Surgery
3.1 Different Surgical Access and Approaches
3.1.1 Thoracic/Lumbar Application
3.1.2 Cervical Application
3.2 Full and Clear Endoscopic Visualization
3.3 Fluid Management
3.4 Soft Tissue Dissection and Removal
3.5 Bone Issue Removal and Resection
3.6 Coagulation and Ablation of Soft Tissue
3.7 Interbody Fusion
References
4: Role of Navigation in Endoscopic Spine Surgery
4.1 Introduction
4.2 Navigation in Endoscopic Spine Surgery
4.3 Clinical Applications
4.4 Navigation Modalities
4.4.1 3D Computerized Navigation
4.4.2 Ultrasound
4.4.3 Mixed Reality
4.4.4 Robotic
4.5 Conclusion
References
Part II: Cervical Spine
5: Anterior Cervical Endoscopic Discectomy
5.1 Introduction
5.2 PECD Indications
5.3 Contradiction
5.4 Surgical Procedures
5.4.1 Positioning
5.4.2 Location, Anesthesia, Puncture, and Working Channel Placement
5.4.3 Percutaneous Endoscopic Cervical Discectomy (PECD)
5.4.4 Postoperative Management
5.4.5 The Complication of PECD and Its Surgical Outcome
5.5 Summary
References
6: Anterior Endoscopic Cervical Foraminotomy and Discectomy
6.1 Introduction
6.2 Indications and Contraindications
6.2.1 Indications
6.3 Advantages
6.4 Surgical Procedure
6.5 Postprocedural Evaluation
6.6 Clinical Outcome
6.7 Complications and Risks
6.8 Commentary
6.9 Conclusion
References
7: Anterior Cervical Discectomy and Interbody Fusion by Endoscopic Approach
7.1 Introduction
7.2 Advantages of Endoscopic ACDF
7.3 Indications [3]
7.4 Contraindications [3]
7.5 Author Preferred Technique
7.5.1 Patient Positioning
7.5.2 Portal Design
7.5.3 Step-by-Step Description of the Technique
7.5.4 Complications and Management
7.5.5 Outcome
7.6 Summary
References
8: Anterior Endoscopic Cervical Transcorporeal Approach
8.1 Introduction
8.2 Evolution of the Anterior Cervical Transcorporeal Tunnel Approach; From the Transuncal Microforaminotomy to the Endoscopic Transvertebral Route
8.3 Biomechanical Perspective
8.4 Rationale and Special Considerations of Anterior Transcorporeal Endoscopic Approach
8.5 Indications and Prerequisites for Anterior Endoscopic Transcorporeal Tunnel Approach
8.6 Surgical Technique
8.7 Perioperative Care
8.8 Complications Related to the Cervical Anterior Transcorporeal Approach
8.9 Discussion
8.10 Conclusion
References
9: Posterior Endoscopic Cervical Foraminotomy
9.1 Introduction
9.2 Indications [5]
9.3 Contraindications
9.4 Author Preferred Technique
9.4.1 Preoperative Planning
9.4.2 Patient Positioning
9.4.3 Portal Design
9.4.4 Step-by-Step Description of the Technique
9.4.5 Complications and Management
9.4.6 Postoperative Care
9.5 Summary
References
10: Posterior Endoscopic Cervical Discectomy
10.1 Introduction
10.2 Indications
10.3 Contraindications
10.4 Author Preferred Technique [4–6]
10.4.1 Preoperative Planning
10.4.2 Patient Positioning
10.4.3 Portal Design
10.4.4 Step-by-Step Description of the Technique
10.4.5 Complications [6, 8, 9]
10.4.6 Postoperative Care
10.4.7 Outcome
10.5 Summary
References
11: Posterior Cervical Percutaneous Endoscopic Ventral Bony Decompression
11.1 Introduction
11.2 Indications
11.3 Contraindications
11.4 Author’s Preferred Technique
11.4.1 Preoperative Planning
11.4.2 Patient Positioning
11.4.3 Portal Design
11.4.4 Step-by-Step Description of the Technique
11.4.4.1 Approach Planning
11.4.4.2 Anatomical Landmarks
11.4.4.3 Ventral Bony Decompression (Intraforaminal)
11.4.4.4 Ventral Bony Decompression (in the Lateral Spinal Canal)
11.5 Outcomes and Complications
11.6 Postoperative Care
11.7 Summary
References
12: Cervical Endoscopic Unilateral Laminotomy for Bilateral Decompression (CE-ULBD)
12.1 Introduction
12.2 Indications
12.3 Contraindications
12.4 Author’s Preferred Technique
12.4.1 Preoperative Planning
12.4.2 Patient Positioning
12.4.3 Portal Design
12.4.4 Step-by-Step Description of the Technique
12.4.4.1 Approach Planning
12.4.4.2 Incision Placement
12.4.4.3 Anatomical Landmarks
12.4.4.4 Decompression
12.5 Outcomes and Complications
12.6 Postoperative Care
12.7 Summary
References
13: Transoral Endoscopic Resection of High Cervical Osteophytes
13.1 Introduction
13.2 Indications for Transoral Endoscopic Approach
13.3 Contraindications
13.4 Author’s preferred Technique
13.4.1 Preoperative Planning
13.4.2 Patient and Medical Team Positioning
13.4.3 Portal Design
13.4.4 Step-by-Step Description of the Technique
13.4.5 Complications and Management
13.4.6 Postoperative Care
13.4.7 Outcome
13.5 Summary
References
14: Full Endoscopic Drainage of Cervical Epidural Abscess
14.1 Introduction
14.1.1 Spinal Epidural Abscess
14.2 Cervical Spinal Epidural Abscess
14.2.1 Recognition of SEA
14.2.2 Anterior or Posterior Approach to C-SEA
14.2.3 Surgical Procedures for C-SEA
14.3 Full Endoscopic C-SEA Drainage
14.3.1 Anterior Transcorporeal Full Endoscopic Drainage
14.3.1.1 Surgical Technique
14.3.2 Anterior Transdiscal Full Endoscopic Drainage
14.3.2.1 Surgical Technique
14.3.3 Posterior Approach Full Endoscopic C-SEA Drainage
14.3.3.1 Surgical Technique
14.4 Summary
References
Part III: Thoracic Spine
15: Fully Endoscopic Transforaminal Discectomy Under Local Anesthesia for Thoracic Disc Herniations
15.1 Introduction
15.2 Operative Techniques
15.3 Clinical Results
15.4 Discussion
15.5 Conclusion
References
16: Full Endoscopic Posterior Decompression for Thoracic Myelopathy Caused by Ossified Ligamentum Flavum
16.1 Introduction
16.2 Evaluation and Diagnosis
16.3 Treatment
16.3.1 Full Endoscopic Surgeries for TOLF
16.3.2 Technical Variations of the Endoscopic Surgeries for the Resection of TOLF
16.3.3 Authors’ Preferred Surgical Techniques
16.4 Conclusions
References
17: Fully Endoscopic ULBD (Unilateral Laminotomy Bilateral Decompression) for Thoracic Spinal Stenosis
17.1 Introduction
17.2 Operative Technique
17.3 Case Series and Results
17.4 Discussion
References
18: Endoscopically Assisted Transforaminal Thoracic Interbody Fusion
18.1 Introduction
18.2 Indications
18.3 Contraindications
18.4 Author Preferred Technique
18.4.1 Preoperative Planning
18.4.2 Patient Positioning
18.4.3 Portal Design
18.4.4 Step-by-Step Description of the Technique
18.4.5 Complications and Management
18.4.6 Outcome
18.5 Summary
References
19: Video-Assisted Thoracoscopic Surgery for Drainage of Paravertebral Abscess
19.1 Introduction
19.2 Indications
19.3 Contraindications
19.4 Author’s Preferred Technique
19.4.1 Preoperative Planning
19.4.2 Patient Positioning
19.4.3 Operating Room Setup
19.4.4 Port Placement
19.4.5 Step-by-Step Description of the Technique
19.4.6 Complications and Management
19.4.7 Postoperative Care
19.5 Summary
References
20: Video-Assisted Thoracoscopic Surgery (VATS) for Spinal Conditions
20.1 Introduction
20.1.1 Technology
20.1.2 Optical Advantage
20.1.3 Minimally Invasive Advantage
20.1.4 Anterior Spinal Surgical Approach Advantage (as Compared to Posterior Surgical Spinal Approach) for Scoliosis Deformity Correction
20.2 Indications
20.3 Contraindications
20.4 Surgical Anatomy and its Clinical Relevance
20.4.1 Approach
20.4.2 Disc
20.4.3 Rib Head
20.4.4 Segmental Vessels (Fig. 20.2)
20.4.5 Sympathetic Chain: Splanchnic Nerve
20.4.6 Intraoperative Spinal Level Localization
20.5 Author’s Preferred Surgical Technique: VATI for AIS Surgery
20.5.1 Anesthesia
20.5.2 Patient and Surgical Team Positioning
20.5.3 Principle of Endoscopic Portal Placements
20.5.3.1 Posterolateral Approach
20.5.4 VATS Portal Localization
20.5.5 VATS Portal Insertion
20.6 Surgical Technique
20.6.1 VATS Discectomy for Anterior Spinal Release and Fusion for AIS Surgery
20.6.2 VATS Discectomy for Spinal Cord Decompression
20.6.3 Spinal Instrumentation and Fusion for a Right-Sided Adolescent Idiopathic Scoliosis
20.6.3.1 Vertebral Screw Insertion
20.6.3.2 Rod Engagement and Scoliosis Deformity Reduction
20.6.3.3 Wound Closure and Postoperative Care
20.6.3.4 Case Presentation
20.7 VATS Complications (Table 20.2)
20.8 Conclusion
References
Part IV: Lumbar Spine
21: Transforaminal Endoscopic Lumbar Discectomy
21.1 Introduction
21.2 Indications
21.3 Contraindications
21.4 Author Preferred Technique
21.4.1 Preoperative Planning
21.4.2 Patient Positioning
21.4.3 Portal Design
21.4.4 Step-by-Step Description of the Technique
21.4.5 Complications and Management
21.4.6 Postoperative Care
21.5 Summary
References
22: Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PE-TILF)
22.1 Introduction
22.2 Indications
22.3 Contraindications
22.4 Author’s Preferred Technique
22.4.1 Preoperative Planning
22.4.2 Patient Positioning
22.4.3 Incision Design
22.4.4 Step-by-Step Description of the Technique
22.4.5 Complications and Management
22.4.5.1 Nerve Root and Dural Injury
22.4.5.2 Cage Displacement and Collapse of the End Plate
22.4.5.3 Surgical Site Infection
22.4.6 Postoperative Care
22.4.7 Outcomes
22.4.7.1 Clinical Efficacy Evaluation
22.4.7.2 Evaluation of Fusion Condition
22.5 Summary
References
23: Endoscopic Foraminotomy in Patients with Moderate Degenerative Deformity of the Lumbar Spine
23.1 Introduction
23.2 Indications
23.3 Contraindications
23.4 Author Preferred Technique
23.4.1 Preoperative Planning
23.4.2 Patient Positioning
23.4.3 Portal Design
23.4.4 Endoscopic Foraminal Decompression
23.4.5 Complications
23.4.6 Postoperative Care
23.4.7 Outcome
23.5 Summary
References
24: Transforaminal Endoscopic Lateral Recess Decompression
24.1 Introduction
24.2 Indications
24.3 Contraindications
24.4 Author Preferred Technique
24.4.1 Preoperative Planning
24.4.2 Patient Positioning
24.4.3 Portal Design
24.4.4 Step-by-Step Description of the Technique
24.4.4.1 Transforaminal Approach
24.4.4.2 Endoscopic View
24.4.4.3 Bone Work
24.4.4.4 Soft Tissue Work
24.4.4.5 Finish
24.4.5 Complications and management
24.4.6 Postoperative Care
24.4.7 Outcome
24.5 Summary
References
25: Interlaminar Endoscopic Lumbar Discectomy
25.1 Introduction
25.2 Indications
25.3 Contraindications
25.4 Author’s Preferred Technique
25.4.1 Preoperative Planning
25.4.2 Patient Positioning
25.4.3 Portal Design
25.4.4 Step-by-Step Description of the Technique
25.4.5 Complications and Management
25.4.6 Postoperative Care
25.5 Summary
References
26: Interlaminar Endoscopic Lateral Recess Decompression
26.1 Introduction
26.2 Indications for Interlaminar Endoscopic Lateral Recess Decompression
26.3 Contraindications
26.4 Author’s Preferred Technique
26.4.1 Preoperative Planning
26.4.2 Patient Positioning
26.4.3 Portal Design
26.4.4 Step-by-Step Description of the Technique
26.4.5 Complications and Management
26.4.6 Postoperative Care
26.5 Summary
References
27: Full Endoscopic Interlaminar Contralateral Endoscopic Lumbar Foraminotomy
27.1 Introduction
27.2 Surgical Anatomical Considerations
27.3 Causes of Foraminal Stenosis
27.4 Indications and Contraindications
27.5 Instruments Required for Surgery (Fig. 27.2)
27.6 Surgical Technique
27.6.1 Preoperative Planning
27.6.1.1 Plain Radiograph
27.6.1.2 Magnetic Resonance Imaging (MRI) and CT Scan
27.6.2 Mode of Anaesthesia
27.6.3 Positioning and Skin Incision
27.6.4 Surgical Equipment
27.6.5 Skin Surface Marking and Docking of Endoscope
27.6.6 Endoscopic Anatomy and Path of Endoscopic Drilling
27.6.7 Foraminal and Extraforaminal Decompression
27.6.8 Evaluation for Adequacy of Decompression
27.6.9 Postoperative Rehabilitation Protocol
27.7 Technical Pearls
27.7.1 Careful Haemostasis of Intraoperative Bleeding
27.7.2 Prevent Dorsal Root Ganglion Manipulation
27.7.3 Recurrence of Foraminal Disc Herniation
27.7.4 Iatrogenic Instability
27.7.5 Representative Case (Figs. 27.5 and 27.6)
27.8 Conclusion
References
28: Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression
28.1 Introduction
28.2 Indications for Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression
28.3 Contraindications
28.4 Author’s Preferred Technique
28.4.1 Preoperative Planning
28.4.2 Patient Positioning
28.4.3 Portal Design
28.4.3.1 Surgical Instrument (Fig. 28.1)
28.4.4 Step-by-Step Description of the Technique
28.4.5 Complications and Management
28.4.6 Postoperative Care
28.5 Summary
References
29: Biportal Endoscopic Technique in the Treatment of Lumbar Spinal Stenosis
29.1 Introduction
29.2 Indications
29.3 Contraindications
29.4 Authors’ Preferred Technique
29.4.1 Preoperative Planning
29.4.2 Patient Positioning
29.4.3 Portal Design
29.4.4 Step-by-Step Description of the Technique
29.4.5 Complications and Management
29.4.6 Postoperative Care
29.5 Summary
References
30: Endoscopic Extraforaminal Lumbar Discectomy
30.1 Introduction
30.2 Indications
30.3 Contraindications
30.4 Author’s Preferred Technique
30.4.1 Preoperative Planning
30.4.2 Patient Positioning
30.4.3 Portal Design
30.4.4 Step-by-Step Description of the Technique
30.4.4.1 Insertion of Guide Needle
30.4.4.2 Insertion of Dilator
30.4.4.3 Insertion of Working Cannula
30.4.4.4 Removal of Herniated Disk
30.4.4.5 Foraminoplasty
30.4.4.6 Complications and Management
30.4.5 Postoperative Care
30.4.6 Outcome
30.4.6.1 Postoperative Dysesthesia
30.4.6.2 Reoperation Cases
30.5 Summary
References
31: Percutaneous Endoscopic Lumbar Discectomy: Transpedicular Approach
31.1 Introduction
31.2 Indications
31.3 Contraindications
31.4 Author’s Preferred Technique
31.4.1 Preoperative Planning
31.4.2 Patient and Medical Team Positioning
31.4.3 Portal Design
31.4.3.1 Location
31.4.3.2 Establishment of the Working Channel
31.4.4 Step-by-Step Description of the Technique
31.4.4.1 Expose and Observe the Spinal Canal Structures
31.4.4.2 Resection of the Prolapsed Nucleus Pulposus
31.4.4.3 Before Ending the Operation
31.4.5 Complications and Management
31.4.6 Postoperative Care
31.4.7 Outcomes
31.5 Summary
References
32: Extraforaminal Approach of Biportal Endoscopic Spine Surgery
32.1 Introduction
32.2 Indications
32.3 Contraindications
32.4 Author’s Preferred Procedure
32.4.1 Preoperative Planning
32.4.2 Patient Preparation
32.4.3 Portal Design
32.4.4 Step-by-Step Description of the Technique
32.4.5 Complications and Management
32.4.6 Postoperative Care
32.4.7 Outcomes
32.5 Summary
References
33: Trans-Sacral Endoscopic Laser Decompression for Herniated Lumbar Disc
33.1 Introduction
33.2 Indication and Contraindications
33.3 Anesthesia and Surgical Preparation
33.4 Procedure
33.5 Postoperative Management
33.6 Complications
33.7 Current Evidence and Pitfalls
References
34: Trans-Superior Articular Process Endoscopic Lumbar Approach
34.1 Introduction
34.2 Indication and Contraindication
34.3 Surgical Procedure
34.3.1 Preoperative Planning
34.3.2 Patient Positioning and Skin Marking
34.3.3 J-Needle Incision and Working Corridor Creation
34.3.4 Bony Landmark Identification
34.3.5 Decompression of the Foramen
34.3.6 Decompression of the Lateral Recess
34.4 Pearls and Pitfalls
34.5 Outcomes and Complications
34.6 Discussion and Summary
References
35: Endoscopic Lateral Lumbar Interbody Fusion
35.1 Introduction
35.2 Indications
35.3 Contraindications
35.4 Surgical Techniques
35.4.1 Patient Position
35.4.2 Skin Incision
35.4.3 Approach to Retroperitoneal Space
35.4.3.1 Approach to the Iliac Crest (L4/5, L5/S1)
35.4.3.2 Intermuscular Approach (L1/2, L2/3, L3/4)
35.4.4 Splitting the Psoas Major Muscle and the Exposing of the Intervertebral Disc Surface
35.4.5 Operation in the Intervertebral Disc
35.4.6 Cage Insertion
35.4.7 Confirmation after Cage Insertion
35.4.8 Wound Closure
35.4.9 Additional Posterior Reduction
35.4.10 Postoperative Care
35.4.11 ELLIF in the Prone Position
35.5 Cases
35.6 Summary
References
36: Endoscopic Treatment of L5-S1 Intervertebral Disc Herniation Via Trans-Iliac Approach
36.1 Introduction
36.2 Indications
36.3 Contraindications
36.4 Author’s Preferred Technique
36.5 Complications and Management
36.6 Postoperative Care
36.7 Summary
References
37: Percutaneous Endoscopic Transforaminal Decompression for Lumbar Spinal Stenosis
37.1 Introduction
37.2 Indications of Percutaneous Endoscopic Transforaminal Decompression (PETD)
37.3 Contraindications of PETD
37.4 Author’s Preferred Technique (PETD)
37.4.1 Preoperative Planning
37.4.2 Patient Positioning
37.4.3 Portal Design
37.4.4 Step-by-Step Description of the Technique
37.4.5 Complications and Management
37.4.6 Postoperative Care
37.4.7 Outcome
37.5 Summary
References
38: Full-Endoscopic Oblique Lateral Lumbar Interbody Fusion
38.1 Introduction
38.2 Indications
38.3 Contraindications
38.4 Author’s Preferred Technique
38.4.1 Preoperative Planning
38.4.2 Patient Positioning
38.4.3 Portal Design
38.4.4 Step-by-Step Description of the Technique
38.4.4.1 OLLIF
38.4.4.2 Full-Endoscopic Decompression
38.4.4.3 Percutaneous Pedicle Screw System Fixation
38.4.4.4 Ending the Operation
38.4.5 Complications and Prevention
38.4.6 Postoperative Care
38.4.7 Outcome
38.5 Summary
References
39: Endoscopic Discectomy-Assisted Oblique Lumbar Interbody Fusion
39.1 Introduction
39.2 Methods or Surgical Technique
39.2.1 Surgical Indication
39.2.2 Information for the Patient
39.2.3 Patient Positioning
39.2.4 Instruments
39.3 Surgical Procedure
39.3.1 Skin Incision
39.3.2 Approach
39.3.3 Disc Preparation
39.3.4 Endoscopic Discectomy
39.3.5 Cage Trialing
39.3.6 Cage Insertion
39.3.7 Pedicular Screw Insertion
39.4 Complications
39.5 Case Presentation
39.6 Discussion (Including how to Avoid Complications, Pearls, Tricks, and Tips by an Expert)
39.7 Conclusions
References
40: Laparoscopic Lumbar Discectomy and Artificial Disc Replacement
40.1 Introduction
40.2 Advantages and Disadvantages of Laparoscopic Lumbar Spinal Surgery
40.2.1 Advantages
40.2.2 Deficiencies
40.3 Indications
40.4 Contraindications
40.5 Surgical Procedure [2, 3]
40.5.1 Preoperative Planning
40.5.2 Patient Positioning and Anesthesia
40.5.3 Portal Design
40.5.4 Step-by-Step Description of the Technique
40.5.5 Complications and Management
40.5.6 Postoperative Care
40.5.7 Surgical Efficacy and Evaluation
40.6 Prospect
References
41: Endoscopic Treatment for Lumbar Infectious Spondylitis
41.1 Introduction
41.2 Indications
41.3 Contraindications
41.4 Surgical Techniques of Transforaminal FEDD
41.4.1 Required Instruments
41.4.2 Preparation before Operation
41.4.3 Docking the Endoscope
41.4.4 Full-Endoscopic Debridement
41.4.5 Postoperative Care
41.5 Complications and Management
41.6 Conclusion
References
42: Endoscopic Treatment of Spinal Tuberculosis
42.1 Introduction
42.2 Instruments
42.3 Indications
42.4 Contraindications
42.5 Incision
42.6 Procedure
42.7 Closure and Drainage
42.8 Possible Complications and Management
42.9 Current Evidence and Pitfalls
42.10 Case Presentation
42.11 Conclusions
References
43: Full-endoscopic Rhizotomy of the Sacroiliac Joint Complex for Low Back Pain
43.1 Introduction
43.1.1 Anatomy
43.1.2 Indications
43.2 Surgical Technique
43.2.1 Operating Room Setup
43.2.2 Working Cannula Docking and Endoscopic Rhizotomy
43.2.3 Endpoint of the Procedure
43.2.4 Case Illustration
43.3 Pitfalls and Complication Avoidance
43.4 Conclusion
References
44: Endoscopy in Pain Therapy
44.1 Endoscopic Approach to Low Back Pain
44.2 Surgical Technique
44.3 Sacroiliac Joint
44.4 Learning Curve
44.5 Endoscopy in Pain Therapy: Future Applications
References
45: Percutaneous Endoscopic Lumbar Annuloplasty and Nucleoplasty for Discogenic Low Back Pain
45.1 Introduction
45.2 Sources of Low Back Pain
45.2.1 Discogenic Pain
45.2.2 Diagnosis of Discogenic Pain
45.2.3 Special Findings on Lumbar MRI
45.3 Percutaneous Endoscopic Lumbar Annuloplasty and Nucleoplasty for Discogenic Low Back Pain
45.3.1 Indications and Prerequisites for PELAN
45.3.2 Surgical Technique
45.3.3 Perioperative Care
45.3.4 Important Considerations
45.4 Discussion
45.5 Conclusion
References
Part V: Other Issues on Endoscopy of the Spine for Academic Search
46: Endoscopic Revision Spine Surgery
46.1 Introduction
46.2 Indications
46.3 Contraindications
46.4 Author-Preferred Technique
46.4.1 Preoperative Planning
46.4.2 Patient Positioning
46.4.3 Portal Design
46.4.4 Step-by-Step Description of the Technique
46.4.5 Complications and Management
46.4.5.1 Dural Tears
46.4.5.2 Exiting Root Injury
46.4.5.3 Infection of the Surgical Site
46.4.5.4 Developing Seizure
46.4.6 Postoperative Care
46.4.7 Outcome
46.5 Summary
References
47: Robotic-Assisted Endoscopic Laminotomy
47.1 Introduction
47.2 Indications
47.3 Contraindications
47.4 Author’s Preferred Technique
47.4.1 Preoperative Planning
47.4.2 Patient and Medical Team Positioning
47.4.3 Portal Design
47.4.4 Step-by-Step Description of the Technique(S)
47.4.4.1 Robotic-Assisted Percutaneous Targeting Stage
47.4.4.2 Robotic-Assisted Endoscopic Laminotomy Stage
47.4.5 Complications and Management
47.4.6 Post-Operative Care
47.5 Summary
References
48: Endoscopic Treatment for Spinal Metastases
48.1 Introduction
48.2 Preoperative Planning
48.3 Contraindications
48.4 Patient and Medical Team Positioning
48.5 Step-by-Step Description of the Technique
48.6 Technique Limitations
48.7 Outcome
48.8 Conclusion
References
49: Spine Endoscopy Complications, Management, and Treatment
49.1 Introduction
49.2 Wrong Indication
49.2.1 Cervical Endoscopic Spine Surgery
49.2.2 Thoracic Endoscopic Spine Surgery
49.2.3 Lumbar Endoscopic Spine Surgery
49.3 Dural Tear
49.4 Nerve Root Injury
49.5 Postoperative Hematoma
49.6 Recurrences
49.7 Infections
49.8 Conclusion
References