gms | German Medical Science

Introduction: The indication for endoscopic spine surgery is increasing. At present, almost every spine surgeon at least discusses the value of the endoscope in the various potential indications. However, not only that the indication for spinal endoscopic surgery in under intense and diverging discussion, many endoscopic system available are difficult to apply and handle.

Material and methods: Thus, the authors developed a new system for endoscopic spinal surgery. The main goals for this system were easy application and intraoperative handling and avoidance of a difficult and prolonged learning curve for experienced spine surgeons. The system consists of various dilators, two different working sheaths, a 30° optic fixed to the work sheath in a flexible position, and an endoscope holder. Through the work sheath almost all regular microinstruments can be applied.

Results: Since August 2006, 54 spinal surgeries have been performed with this system. Six procedures were performed as a dorsal foraminotomy approach in cervical disc surgery. Forty-eight procedures were done in lumbar disc and lumbar stenosis cases (mean age 55 yrs, range 21–81 yrs). In all intraoperative situations, the system was easy to handle. Mean surgical time scored 88 min. (range 37–206 min). A reduction of radicular pain was observed in all patients (100%). Improvement of preoperative paresis was found in 23 of 32 cases (72%). There was no emergency stopping, no mortality, and no infection. No complications peculiar to the application of the system occurred. In one case, the endoscope was abandoned and the procedure microsurgically continued. There was no neurological deficit and no CSF leakage. However, three recurrent disc prolapses (6%) occurred in the 6 month follow up.

Conclusion: In all, the system was easy and safe to handle. Good postoperative results were observed. However, the rather high rate of early postoperative recurrences needs further investigation.