Endoscopic procedures for the lumbar spine: A comprehensive view

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.