Basic of Spine Endoscopy

Dr.dr. Jainal Arifin, M.Kes, Sp.OT(K)Spine

Why Minimally Invasive Spine Surgery?
• A basic tenet of surgery is to effectively treat
• pathology with minimal disturbance of normal anatomy: leaving "the
smallest footprint."
Why Minimally Invasive Spine Surgery?
• A basic tenet of surgery is to effectively treat
• pathology with minimal disturbance of normal anatomy: leaving "the
smallest footprint.“
• Small incisions
•
• Illumination •
Minimizes tissue trauma
Post-operative pain
• Magnification • Hospital stay
• Better cosmesis
• Instrumentation • Less tissue disruptions
Basic principles of minimal invasive
1. Avoid muscle crush injury by self-retaining retractors;
2. Do not disrupt tendon attachment sites of key muscles, particularly
the origin of the multifidus muscle at the spinous process;
3. Use known anatomic neurovascular and muscle compartment
planes; and
4. Minimize collateral soft-tissue injury by limiting the width of the
surgical corridor.
Benefits of minimal invasive
• Intra-operative
• Smaller incisions
• Reduced blood loss
• Less soft tissue damage
• Reduced muscle retraction
• Possibility of performing on
outpatient basis
• Post-operative
• Smaller scars/less scar tissue Less
pain
• Decreased postoperative narcotics
• Shorter hospital stay
• Faster recovery
• Quicker return to work and
activities
• Endoscopy
• Endos  Greek word for inside or within
• Scope  Instrument for viewing
• Endoscopy is a procedure in which an endoscope is introduced into
the body to give a view of its internal parts
• Endoscope is an illuminated usually fiber optic flexible or rigid
tubular instrument for visualizing the interior of a hollow organ or part
for diagnostic or therapeutic purposes that typically has one or
more channels to enable passage of instruments
Conventional MIS Full
open surgery Microscopic Endoscopic endoscopic
(1970) surgery (1980) assisted (1990) (2000)

History
PEL
D
Why Full Endoscopic Spine Surgery?
• PROS
• Fully minimal invasive technique
• NO destabilizing effect → Less
injury to the muscle
• Less subsequent scar formation
• Direct access to the pathology
• Reduce risk of infection
• Short rehabilitation time
• Short hospital length of stay
• CONS
• Need experience
• 3 dimensional imagination with 2
dimensional control
• Stereotactical work and
maneuvering
• Technically demanding
• Learning curve
• Equipment requirement
Endoscopic View Prespective
View Prespective
Choices of Lumbar Endoscopic Surgery
Indication
• Lumbar Disc Herniation
• Central
• Paracentral
• Foraminal
• Extraforaminal
• Stenosis Canalis
• Infection
• Medial branch rhizotomy
• Interbody fusion.
Choices of Lumbar Endoscopic Surgery
Transforaminal PELD
• Pro
• Local/sedation anesthesia
• One day care Procedure
• Preserving flavum ligament
• Less possibility of nerve injury
• Cons
• Limited indication
• Needle placement
• Learning curve → Difficult
evaluation of structure
Interlaminar PELD
• Pro
• Wider indication
• One day care procedure
• Familiar surgical view
• Cons
• Need regional or general
anesthesia
• Learning curve → Difficult in
handling the instrument
• Possibility of nerve injury
Basic Equipment for Spine Endoscopy
• Radiolucent operating table
• Spine endoscope
• Operating instrument: Surgical forceps, punch,
trephine
• Endoscopy cart: Video monitor, light source,
video recording device, irrigation pump
• C-Arm fluoroscopy
• Radiofrequency generator
• Motorized endoscopic drill →→ Not always
necessary
Basic Instrument
Operating Room Setup
Patient’s Position
• Position  Very important
• Aim  Open the foramen or the interlaminar space
Image Intensifier
• Find the perfect true AP
• Both upper and lower endplate and
lower endplate → One line
• Spinous process on the center of
vertebral body
• Find the perfect true Lateral
• Both upper and lower endplate and
lower endplate → One line
• Anterior and posterior cortex of the
vertebral body → One line
Summary
• Endoscopic Spine surgery is promising.
• The outcome similar with open.
• Can be used for decompression and fusion interbody.
• Steep learning curve.
• Supervised by expert.
• Choose the easy one.
• Need special equipment.
No time to be late for being a wise and success
Tak ada kata terlambat untuk menjadi orang baik dan sukses

"Never discourage anyone... who continually makes progress, no matter how

slow."
-Plato
Greek author & philosopher in Athens (427 BC-347 BC)

Thank you