Development of new surgical treatments in spinal surgery: Expansive open-door laminoplasty and percutaneous nucleotomy

Abstract

The outstanding achievements of two renowned spine surgeons, who are alumni of the Department of Orthopaedic Surgery, Keio University, are described. Anterior decompression followed by fusion and laminectomy had been the standard techniques for cervical myelopathy due to disc herniation, spondylosis and ossification of the posterior longitudinal ligament. However, both techniques were not without certain comorbidities. Dr. Kiyoshi Hirabayashi devised an epoch-making expansive open-door laminoplasty, in which both sufficient posterior decompression and preservation of cervical stability are achieved simultaneously with reduced risk of such complications. Dr. Sadahisa Hijikata is the pioneer of a totally new concept treatment, percutaneous nucleotomy, for lumbar disc herniation, one of the most prevailing diseases that cause low back pain and sciatica. He devised this technique to avoid prolonged conservative treatment with associated suffering of the patients and to minimize the chance of morbidity that is occasionally associated with an open surgery. This technique, together with chemonucleolysis, has led to the establishment of intradical or intermediate treatments which lie between conservative and surgical treatments. Both techniques have not only brought the relief of pain and suffering in numerous patients, but have also opened the door to the development of many new modified procedures and technologies. Most importantly, these two techniques still remain as the most viable choice among various similar modifications. The rationale, indictions, technique as well as the present status and future perspective for these two innovative yet fundamental techniques are introduced and discussed.