Treatment strategies of minimally invasive spinal surgery for lumbar degenerative diseases

Abstract

With the increasing prevalence of spinal degenerative diseases, curative treatment is necessary. Here, we report diagnostic and minimally invasive treatment methods for lumbar degenerative diseases. We describe diffusion tensor imaging as a diagnostic modality and a minimally invasive percutaneous procedure for a herniated lumbar disc. Finally, we report the current status of endoscopic treatment and intraoperative imaging that are effective for spinal cord surgery. Lumbar magnetic resonance imaging can aid the qualitative evaluation and diagnosis of lesions using two‒dimensional images but have limited application in three‒dimensional and quantitative evaluations. Diffusion‒weighted imaging is garnering attention as a method for quantitatively evaluating neural function. Diffusion tensor imaging could help quantify damage to the cauda equina and nerve roots. In recent years, percutaneous nucleotomy with high radiofrequency bipolar systems and chemonucleolysis with condoliase have been performed. Percutaneous nucleotomy uses combined intervertebral disc removal forceps and high‒frequency bipolar modes for intradiscal manipulation. Condoliase reduces the water‒retaining function of glycosaminoglycans in the nucleus pulposus and intradiscal pressure. Here, we explain the current status of endoscopes and intraoperative imaging devices that are effective for spinal cord surgery. Full endoscopic spine surgery is used for lumbar spinal stenosis. Hybrid or cone‒beam and O‒arm intraoperative computed tomography scans are useful. Advances in diagnostic imaging, improvements in surgical techniques, and development of new technologies have made spine surgery effective and safe. In the future, it will be possible to identify lesions causing pain and paralysis based on diagnostic imaging and perform nerve decompression using minimally invasive methods. Furthermore, multi‒level and fusion surgeries will be reduced.