Martin Komp

Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study.

Study Design. Prospective, randomized, controlled study of patients with lumbar disc herniations, operated either in a full-endoscopic or microsurgical technique. Objective. Comparison of results of lumbar discectomies in full-endoscopic interlaminar and transforaminal technique with the conventional microsurgical technique. Summary of Background Data. Even with good results, conventional disc operations may result in subsequent damage due to trauma. Endoscopic techniques have become the standard in many areas because of the advantages they offer intraoperatively and after surgery. With the transforaminal and interlaminar techniques, 2 full-endoscopic procedures are available for lumbar disc operations. Methods. One hundred seventy-eight patients with full-endoscopic or microsurgical discectomy underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: VAS, German version North American Spine Society Instrument, Oswestry Low-Back Pain Disability Questionnaire. Results. After surgery 82% of the patients no longer had leg pain, and 14% had occasional pain. The clinical results were the same in both groups. The recurrence rate was 6.2% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: back pain, rehabilitation, complications, and traumatization. Conclusion. The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, lumbar disc herniations outside and insidethe spinal canal can be sufficiently removed using the full-endoscopic technique, when taking the appropriate criteria into account. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures.

Full-Endoscopic Cervical Posterior Foraminotomy for the Operation of Lateral Disc Herniations Using 5.9-mm Endoscopes : A Prospective, Randomized, Controlled Study

Study Design. Prospective, randomized, controlled study of patients with lateral cervical disc herniations, operated either in a full-endoscopic posterior or conventional microsurgical anterior technique. Objective. Comparison of results of cervical discectomies in full-endoscopic posterior foraminotomy technique with the conventional microsurgical anterior decompression and fusion. Summary of Background Data. Anterior cervical decompression and fusion is the standard procedure for operation of cervical disc herniations with radicular arm pain. Mobility-preserving posterior foraminotomy is the most common alternative in the case of lateral localization of the pathology. Despite good clinical results, problems may arise due to traumatization of the access. Endoscopic techniques are considered standard in many areas, since they may offer advantages in surgical technique and rehabilitation. These days, all disc herniations of the lumbar spine can be operated in full-endoscopic technique. With the full-endoscopic posterior cervical foraminotomy a procedures is available for cervical disc operations. Methods. One hundred and seventy-five patients with full-endoscopic posterior or microsurgical anterior cervical discectomy underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: VAS, German version North American Spine Society Instrument, Hilibrand Criteria. Results. After surgery 87.4% of the patients no longer had arm pain, and 9.2% had occasional pain. The clinical results were the same in both groups. There were no significant difference between the groups in the revision or complication rate. The full-endoscopic technique brought advantages in operation technique, preserving mobility, rehabilitation, and traumatization. Conclusion. The recorded results show that the full-endoscopic posterior foraminotomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.

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.

Study Design. Prospective study of patients with lumbar disc herniations who were operated on with a full-endoscopic uniportal transforaminal approach using an extreme lateral access. Objectives. To examine the technical possibilities of an extreme lateral access for full-endoscopic uniportal transforaminal surgery of lumbar disc herniations within the spinal canal. Also, to assess sufficient decompression, and the advantages and disadvantages of the minimally invasive procedure. Summary of Background Data. Conventional prolapsed disc operations can result in consecutive damage as a result of traumatization. The usual transforaminal access is posterolateral, and is associated with problems in reaching the epidural space directly with unhindered vision and, thus, with problems of sufficient decompression in lumbar disc herniations within the spinal canal. Methods. A total of 463 patients were observed for 1 year. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version North American Spine Society Instrumentarium, Oswestry low back pain disability questionnaire. Results. There were no complications. Of the patients, 81% reported no longer having leg pain, and 14% had occasional pain. There was no worsening. The results were constant and are equal to those of conventional procedures. No patients presented with neural scarring; 7% had recurrence of the prolapse. The extreme lateral access was necessary to reach the sequestered material. Conclusions. The technique presented is an adequate and safe alternative to conventional procedures, and has the advantages of a truly minimally invasive procedure. The extreme lateral access is required for the indications described. There are clear limitations outside these indications. The possibility of selecting an access from posterolateral to extreme lateral now enables surgery of lumbar disc herniations inside and outside the spinal canal.

Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study.

OBJECT Extensive decompression with laminectomy where appropriate is often still described as the method of choice in surgery for lateral recess stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. Transforaminal and interlaminar access provide 2 full-endoscopic (FE) techniques for lumbar spine surgery. The goal of this prospective randomized controlled study was to compare the surgical results for the FE technique via the interlaminar approach with those of the conventional microsurgical technique in patients with degenerative lateral recess stenosis. METHODS A total of 161 patients with FE or microsurgical decompression underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version of the North American Spine Society instrument, and the Oswestry low-back pain disability questionnaire. RESULTS The results show that 74.5% of patients reported no longer having leg pain, and 20.5% had only occasional pain. The clinical results were the same in both groups. The rate of complications and revisions was significantly reduced in the FE group. The FE techniques brought advantages in the following areas: operation, complications, traumatization, and rehabilitation. CONCLUSIONS The clinical results of the FE interlaminar technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique, such as reduced traumatization. The FE interlaminar spinal decompression procedure is a sufficient and safe supplement and alternative to microsurgical procedures.

Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision.

Study Design Prospective, randomized, controlled study of patients with recurrent lumbar disc herniations after conventional discectomy, operated either in a full-endoscopic or microsurgical technique. Objective Comparison of results of lumbar revision discectomies in full-endoscopic interlaminar and transforaminal technique with the conventional microsurgical technique. Summary of Background Data Recurrences after lumbar disc operations cannot be prevented. Because of the existing scarring, the risk of intraoperative complications may be increased and consecutive damage may arise owing to greater traumatization. In disc surgery, tissue-sparing interventions are becoming more widespread. Endoscopic techniques have become the standard in many areas because of the advantages they offer intraoperatively and postoperatively. With the transforaminal and interlaminar techniques, 2 full-endoscopic procedures are available for the lumbar spine. Methods Eighty-seven patients with recurrent herniation after conventional discectomy underwent full-endoscopic or microsurgical intervention and were followed for 2 years. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version of the North American Spine Society Instrument, Oswestry Low-Back Pain Disability Questionnaire. Results Postoperatively, 79% of the patients no longer had leg pain, and 16% had occasional pain. The clinical results were the same in both groups. The re-recurrence rate was 5.7% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: rehabilitation, complications, and traumatization. Conclusions The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, recurrent lumbar disc herniations can be sufficiently removed using the full-endoscopic technique. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures.

Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients.

Study Design Prospective study of the patients with degenerative spinal central stenosis, operated bilateral in a full-endoscopic unilateral technique. Objective The objective of this prospective study was to examine the technical possibilities of full-endoscopic interlaminar bilateral technique with unilateral approach in degenerative lumbar central spinal stenosis and predominant leg symptoms using new designed endoscopes and instruments. Summary of Background Data Extensive decompression with laminectomy where appropriate, is often still described as the method of choice in the operation of degenerative lumbar spinal stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. At the spine, 1 essential point was the developing of the instruments for sufficient bone resection under continuous visual control. This enabled the use in the operation of spinal canal stenoses. Methods A total of 72 patients with lumbar central spinal stenosis full-endoscopic unilateral decompression were followed for 2 years. In addition to general and specific parameters, these measuring instruments were used: VAS, German version North American Spine Society Instrument, Oswestry Low-back Pain Disability Questionnaire. Results The results show that 70.8% no longer have leg pain or it was nearly completely reduced and 22.2% have occasional pain. The decompression results were equal to those of conventional procedures. The complication rate was low. The full-endoscopic techniques brought advantages in these areas: operation, complications, traumatization, and rehabilitation. Conclusions The recorded results show that the full-endoscopic interlaminar bilateral decompression with unilateral approach is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.

Operation of Lumbar Zygoapophyseal Joint Cysts Using a Full-Endoscopic Interlaminar and Transforaminal Approach Prospective 2-Year Results of 74 Patients

In appropriate situations, extensive decompression with laminectomy often continues to be described as the method of choice for operations involving lumbar zygoapophyseal joint (z-joint) cysts. Tissue-sparing procedures are nevertheless becoming more common. Endoscopic techniques have become the standard procedures in many areas because of the advantages they offer in terms of surgical technique and in rehabilitation. One key aspect in spinal surgery was the development of instruments for sufficient bone resection carried out under continuous visual control. This enabled endoscopes to be used when operating on z-joint cysts. The objective of this prospective study was to examine the technical possibilities for the full-endoscopic interlaminar and transforaminal technique in lumbar z-joint cysts. A total of 74 patients were followed up for 2 years. The results show that 85% of the patients no longer have any leg pain or that the pain had been almost completely eliminated, and 11 % experience occasional pain. The complication rate was low. The full-endoscopic techniques brought advantages in the following areas: operation, complications, traumatization, and rehabilitation. The recorded results show that full-endoscopic resection of a z-joint cyst using an interlaminar and transforaminal approach provides an adequate and safe supplement, and is an alternative to conventional procedures when the indication criteria are fulfilled. It also offers the advantages of a minimally invasive intervention.

Endoscopic Procedures for the Lumbar Spine: A Comprehensive View

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.

Navigation of pedicle screws in the thoracic spine with a new electromagnetic navigation system: a human cadaver study.

Introduction. Posterior stabilization of the spine is a standard procedure in spinal surgery. In addition to the standard techniques, several new techniques have been developed. The objective of this cadaveric study was to examine the accuracy of a new electromagnetic navigation system for instrumentation of pedicle screws in the spine. Material and Method. Forty-eight pedicle screws were inserted in the thoracic spine of human cadavers using EMF navigation and instruments developed especially for electromagnetic navigation. The screw position was assessed postoperatively by a CT scan. Results. The screws were classified into 3 groups: grade 1 = ideal position; grade 2 = cortical penetration <2 mm; grade 3 = cortical penetration ≥2 mm. The initial evaluation of the system showed satisfied positioning for the thoracic spine; 37 of 48 screws (77.1%, 95% confidence interval [62.7%, 88%]) were classified as group 1 or 2. Discussion. The screw placement was satisfactory. The initial results show that there is room for improvement with some changes needed. The ease of use and short setup times should be pointed out. Instrumentation is achieved without restricting the operators mobility during navigation. Conclusion. The results indicate a good placement technique for pedicle screws. Big advantages are the easy handling of the system.

The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures

BACKGROUND Neuropathic pain originating from spinal disc herniations is a very common problem. The majority of disc surgeries are performed to alleviate this pain once conservative measures and targeted injections have failed. Endoscopic spinal surgery is increasingly popular because it minimizes access trauma and hastens recovery from the intervention. This clinically oriented review evaluates controlled studies that investigate the clinical results and the complications of full-endoscopic lumbar and cervical procedures for symptomatic disc herniations in comparison to a microsurgical standard procedure. This review focuses exclusively on modern, full-endoscopic disc surgery irrespective of the specific access technique (e.g., interlaminar vs. transforaminal) and irrespective of the spinal region. STUDY DESIGN Comprehensive review of the literature. OBJECTIVE To assess the clinical outcomes and complication rates of full-endoscopic disc surgery compared to the microsurgical standard procedures. METHODS A PubMed and Embase search was performed, considering entries up to January 2013. All 504 results were screened and categorized. Only 4 randomized controlled trials (RCTs) and one controlled studies (CS) could finally be considered for evaluation. All 5 manuscripts were meticulously analyzed with regards to randomization mode, inclusion/exclusion criteria, clinical results, and complication rates. RESULTS Overall, the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, and faster postoperative rehabilitation/shorter hospital stay/faster return to work than the microsurgical techniques. There were no significant differences in the main clinical outcome criteria between the endoscopic and the microsurgical techniques in any of the trials. All 5 studies had fewer complications with the endoscopic technique and this was statistically significant in 2 of the studies. One study showed a lower rate of revision surgeries requiring arthrodesis with the endoscopic technique. LIMITATIONS All 5 studies that could be considered originate from experienced investigators and all 4 RCTs came from one group. This limits the transferability of their results to surgeons less experienced in endoscopic disc surgery. CONCLUSIONS The studies show that full-endoscopic disc surgery can achieve the same clinical results in symptomatic cervical and lumbar disc herniations as the microsurgical standard techniques. This does not appear to come at the price of higher complication rates.