gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

A new interlaminar access for the full-endoscopic uniportal operation of sequestered disc prolapses using a 7-mm endoscope – Prospective results of 528 patients

Ein neuer interlaminärer Zugang für die vollendoskopische uniportale Operation sequestrierter Bandscheibenvorfälle mittels eines 7-Millimeter-Endoskopes. Prospektive Ergebnisse von 528 Patienten.

Meeting Abstract

Suche in Medline nach

  • corresponding author Sebastian Ruetten - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
  • M. Komp - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
  • G. Godolias - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.04.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0277.shtml

Veröffentlicht: 23. April 2004

© 2004 Ruetten et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Full-endoscopic spinal operations offers advantages over open procedure. Endoscopic transforaminal operation of sequestered disk prolapse at L5/S1 and sometimes higher does not permit the new required extreme lateral access due to the pelvis, so that the ventral epidural space cannot be reached. What possibilities are offered by the full-endoscopic uniportal interlaminar access using a 7-mm endoscope?

Methods

Five hundred and ninety-four patients were operated on in 2001/2002 under general anesthesia for disk prolapse. Access was interlaminar. The levels of opration were L5/S1 in 473 cases, L4/5 in 101 cases and L3/4 in 20 cases. A 7-mm endoscope was used in uniportal technique. In addition to special instruments, active moveable bipolar high-frequency electrodes and the holmium:YAG laser in sidefire technique were used. Prospective follow-up lasted 12 months. Five hundred and twenty-eight patients (89 %) could be followed.

Results

No intraoperative complications occurred. The meantime of operation was 29 minutes. Protruding disk material could be excised in 496 cases (94%), only bulging anulus segments were found in 32 cases. There were extensive fibrous adhesions of nerve and Cauda equina in 200 cases (38%). No bony stabilizing segments were resected. The defect in the Ligamentum flavum attained a maximum of 5 millimeters. The maximum hospitalization was 2 days. Four hundred and seventy patients (89%) reported no more radicular leg pain, 42 patients (8%) had transient persistence. 16 patients (3%) reported no essential improvement. There was no deterioration. No post-discotomy syndrome was observed. Recurrence was observed in 21 cases (4 %); these were operated using the same technique in 19 cases, and in open procedure in 2 cases.

Conclusions

Full-endoscopic uniportal interlaminar operation of disk prolapse is a new method. It is a sufficient and safe procedure. There are no anatomical difficulties in access. No clinically symptomatic scarring of the epidural space or instabilities were observed. It offers advantages over open nucleotomy. Further advances can be expected from development and adaptation of the instruments. A broad spectrum of lumbar disk prolapses can now be operated in minimally-invasive endoscopy in combination with the endoscopic transforaminal operation.