baholzer - Endoscopic Spine

20 © baholzer Endoskopie-Systeme GmbH & Co.KG SPINE Introduction to lumbar transforaminal endoscopic disc surgery Brief overview of surgical technique for transforaminal endoscpic surgery 1. PREOPERATIVE WORK UP History and physical examination confirming clinical signs of lumbar radiculopathy as a result of herniated disc or spinal stenosis is an essential part of preoperative work up. Hallmarks of lumbar herniated disc include radiating leg pain, decreased sensation to light touch, pin prick and vibration, positive tension signs such as increased pain with elevation of the leg (positive straight leg raise). Lumbar claudication symptoms are fre- quently described as a predictable reduction of walking endurance followed by pain relief with rest. The pre- operative work up should include up-to-date imaging studies such as MRI or CT scan. Plain film radiography is also recommended to determine the presence of spinal deformity or instability. An interventional work up with transforaminal epidural steroid injections (selective nerve root block) may also be helpful and can often deter- mine whether a patient is an appropriate surgical candidate for the transforaminal decompression procedure. Possible indications for transforaminal endoscopic surgery are: 1.1 INDICATIONS FOR TRANSFORAMINAL ENDOSCOPY a.) Herniated disc Ȋ Contained herniation Ȋ Extruded disc herniation Ȋ Recurrent disc herniation b.) Foraminal or lateral recess stenosis Ȋ Facet hypertrophy Ȋ Ligamentum flavum hypertrophy Ȋ Facet cysts c.) Spondylodiscitis 1.2 PREOPERATIVE PLANNING Preoperative work up is based on MRI and/or CT scan for the morphological/anatomical identification of the pathology. Preoperative imaging studies should also include plain film radiography of the lumbar spine in- cluding extension flexion views, as well as radiographs of the pelvis showing the lumbosacral junction. These imaging studies are useful in access planning and determination of the entry point for the working cannula. The location of the herniated disc or stenotic lesion in relation to the intervertebral disc space as well as the neuroforaminal configuration should be noted prior to surgery. It is often helpful to assess neuroforaminal height and width on preoperative studies to determine the most ap- propriate access to the pathology. Other relevant preoperative considerations relate to understanding any spi- nal deformity, sagittal or coronal imbalance or instability, the configuration of the ilium and the presence of any