What Is Endoscopic Microdiscectomy?

Lateral approach endoscopic discectomy

Lateral approach endoscopic discectomy

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Lateral approach endoscopic discectomy

Lateral approach endoscopic discectomy

Orthopaedics / Spine Surgery / Surgical Treatment of Lumbar Disc Herniation / Endoscopic-assisted Lumbar Discectomy

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In recent years, with the development of endoscopic techniques, the method of applying small incisions and microsurgery lumbar discectomy is basically replaced by posterior discectomy under lumbar discectomy. For some extremely lateral disc herniations, posterior lateral or lateral approach endoscopic lumbar discectomy can be used.

Surgery related anatomy.

Lateral endoscopic discectomy is suitable for:

Lumbar 3 to 4 and 4 to 5 lumbar disc herniations.

1. Recurrent lumbar disc herniation is a relative contraindication.

2. Severe spinal degeneration, spinal instability and other low back and leg pain.

3. Nervous local signs.

4. Herniated nucleus pulposus of intervertebral disc is free to spinal canal.

5. Locate pinched or narrowed nerve root entrance.

It should be excluded from imaging to see whether the puncture channel passes through the internal organs of the abdominal cavity. If it passes, this method should not be selected.

For local anesthesia, the position can be prone or lateral as required.

1. Use the Kirschner wire to determine the direction of the disc in the lateral perspective, and determine the horizontal projection of the intervertebral disc by orthotopic perspective.

2. The distance from the needle insertion point to the posterior midline is 15-22cm. Routine disinfection, single list, local anesthesia with 1% lidocaine, X-ray machine guides the puncture needle into the intervertebral space plane, and enters the spinal canal in front of the superior articular process.

3. Insert the guide wire from the puncture needle and withdraw the puncture needle, and a 7 mm incision is made with a No. 10 blade. The dilation tube enters the spinal canal under the guidance of the guide wire and exits the guide wire. The dilatation tube is guided under the working cannula to reach the depth in the spinal canal. Withdraw the expansion tube and the ring drill cuts the fiber ring.

4. Insert the endoscope to remove the protruding disc tissue under direct vision. After the intervertebral disc tissue was cleaned under direct vision, gentamicin 80,000 to 160,000 U was injected locally. Band-Aid Adhesive.

1. When placing the dilatation tube and working tube, do not use rough movements. Pay attention to communicate with the patient to prevent damage to the nerve root.

2. If there is bleeding under the microscope, stop bleeding in time and avoid blind operation.

3. The protruded disc should be removed as far as possible to try to completely relieve the preoperative symptoms.

1. Lateral approach endoscopic discectomy 1. ipsilateral or contralateral nerve root injury

Nerve nucleus pulposus operation with non-direct view results in nerve root damage.

2. Lateral approach endoscopic discectomy 2. dural sac rupture

Puncture and ring drilling can rupture the dural sac without special treatment.

3. Lateral approach endoscopic discectomy 3. total spinal anesthesia

If the puncture enters the dural sac during surgery, and the local anesthetic is not used in time, it will lead to total spinal anesthesia.

4. Lateral approach endoscopic discectomy 4. Central infection

Dural sac rupture combined with intervertebral space infection, occasionally a central infection, manifested as severe headache, stiff neck.