Full-endoscopic lumbar and cervical surgery for disc herniation

Abstract

The history of the surgery for lumbar disc herniation began about 80 years ago, in fact in 1934, when Mixter and Barr reported the transdural removal of a lumbar disc herniation [ 4 ]. To introduce the concept of minimally invasive techniques, since the early 1970s, neurosurgeons have been performing a microsurgical procedure using a microscope to treat lumbar disc herniations through the open interlaminarapproach as described by Yasargil and Williams [ 8, 9 ]. In using this technique, the surgeon must detach the multifi dus muscle from the midline, remove the yellow ligament and some fatty tissues, coagulate vessels, and manipulate the nerve root. Although this technique hasbeen associated with very good results, some patients, about 10 %, can develop scarring of the epidural space and recurrence of the sciaticpain [ 1 ]. To overcome the aforementioned complication, also starting from this decade, are the percutaneous discectomy techniques, fi rst only with fl uoroscope guidance as described by Hijikata and then with an arthroscope as described by Kambin. At this time, an arthroscope was used only to inspect the annulus and the disc, but the discectomy was done under fl uoroscopic guidance. Anthony Yeung developed the fi rst working channel endoscope which allowed constant real- time visualization and discectomy with a uniportal technique [ 10 ].