Future suggestions

Abstract

From the initializing breakthrough in 1934, where a herniated disk was correctly described for the first time and treated with an open surgical approach, spine surgery has become an own sophisticated area of expertise and a meaningful innovation driver in medical technology. Development in this complex field was characterized on the one hand by the surgeons’ constant endeavor to find more minimally invasive approaches using the most elegant routes through natural access points like the foramina to the spinal canal. On the other hand, there were quantum leaps in medical technology allowing to constantly reduce invasiveness. Visualization options went from the naked eye, through microscopy up to fiber optic light sources and full HD displays. Instrumentation developed from conventional scalpel and forceps to miniature instruments and sophisticated tools like motor driven burrs or HF probes. This now allows for efficient manipulation at the site of pathology through a single access point with modern endoscopes providing angulated bright illumination and yet sufficiently wide working channel. Percutaneous options in spinal endoscopy have developed from the sole removal of nucleus material to the successful treatment of central stenosis, the removal of foreign bodies or spinal cysts. Also, they have extended from the lumbar spine to thoracic and cervical interventions. However, they are still associated with a considerable learning curve and extensive experience is mandatory. Future challenges are manifold-to be named are reducing X-ray exposure, broadening of applications and still improving the safety of the techniques. Neuromonitoring, 3D optics, and navigation are considered promising upcoming technologies in this regard.