The Role and Future of Endoscopic Spine Surgery

1. Ishimoto Y, Yoshimura N, Muraki S, et al. Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Osteoarthritis Cartilage ;20:-8.

Check now

2. Kim JH, Kim HS, Kapoor A, et al. Feasibility of full endoscopic spine surgery in patients over the age of 70 years with degenerative lumbar spine disease. Neurospine ;15:131-7.

3. Kim M, Kim HS, Oh SW, et al. Evolution of spinal endoscopic surgery. Neurospine ;16:6-14.

4. Hasan S, Hofstetter CP. Endoscopic spine surgery past, present, and future. Bull Hosp Jt Dis () ;77:75-84.

5. Brusko GD, Wang MY. Endoscopic lumbar interbody fusion. Neurosurg Clin N Am ;31:17-24.

6. Quillo-Olvera J, Lin GX, Kim JS. Percutaneous endoscopic cervical discectomy: a technical review. Ann Transl Med ;6:100.

7. Ruetten S, Hahn P, Oezdemir S, et al. Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach. J Neurosurg Spine ;29:157-68.

8. Kotheeranurak V, Jitpakdee K, Pornmeechai Y, et al. Posterior endoscopic cervical decompression in metastatic cervical spine tumors: an alternative to palliative surgery. J Am Acad Orthop Surg Glob Res Rev ;6:e22..

9. Beisse R. Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J ;19 Suppl 1(Suppl 1):S52-65.

10. Mayer HM. A history of endoscopic lumbar spine surgery: what have we learnt? Biomed Res Int ;:.

11. Truumees E. A history of lumbar disc herniation from Hippocrates to the s. Clin Orthop Relat Res ;473:-95.

12. Yasargil MG. Microsurgical operation of herniated lumbar disc. In: Wüllenweber R, Brock M, Hamer J, et al., editors. Lumbar disc adult hydrocephalus. Berlin: Springer; . p. 81Advances in Neurosurgery, vol 4.

13. Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. In: Wüllenweber R, Brock M, Hamer J, et al., editors. Lumbar disc adult hydrocephalus. Berlin: Springer; . p. 74-80. Advances in Neurosurgery, vol 4.

14. Kambin P, Sampson S. Posterolateral percutaneous suctionexcision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res ;(473):37-43.

15. Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years&#; experience. Clin Orthop Relat Res ;(238):9-23.

16. Forst R, Hausmann B. Nucleoscopy--a new examination technique. Arch Orthop Trauma Surg () ;101:219-21.

17. Kambin P, Nixon JE, Chait A, et al. Annular protrusion: pathophysiology and roentgenographic appearance. Spine (Phila Pa ) ;13:671-5.

18. Schreiber A, Suezawa Y, Leu H. Does percutaneous nucleotomy with discoscopy replace conventional discectomy? Eight years of experience and results in treatment of herniated lumbar disc. Clin Orthop Relat Res ;(238):35-42.

19. Hofstetter CP, Ahn Y, Choi G, et al. AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures. Global Spine J ;10(2 Suppl):111S-121S.

20. Yeung AT. Minimally invasive disc surgery with the yeung endoscopic spine system (YESS). Surg Technol Int ;8:267-77.

21. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech ;18 Suppl:S1-6.

22. Perez-Cruet MJ, Foley KT, Isaacs RE, et al. Microendoscopic lumbar discectomy: technical note. Neurosurgery ;51(5 Suppl):S129-36.

23. Choi KC, Lee JH, Kim JS, et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10 228 cases. Neurosurgery ;76:372-81.

24. Kim SK. Quantity of operators with Bhatia&#;Šemrl property. Linear Algebra Its Appl ;537:22-37.

25. Lin GX, Huang P, Kotheeranurak V, et al. A systematic review of unilateral biportal endoscopic spinal surgery: preliminary clinical results and complications. World Neurosurgery ;125:425-32.

26. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy ;12:330-4.

27. DeAntoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: technique and clinical results. J South Orthop Assoc ;7:6-12.

28. Soliman HM. Irrigation endoscopic decompressive laminotomy. A new endoscopic approach for spinal stenosis decompression. Spine J ;15:-9.

29. Min WK, Kim JE, Choi DJ, et al. Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis. J Orthop Sci ;25:371-8.

30. Kim HS, Wu PH, Jang IT. Current and future of endoscopic spine surgery: what are the common procedures we have now and what lies ahead? World Neurosurg ;140:642-53.

31. Kim HS, Paudel B, Jang JS, et al. Percutaneous endoscopic lumbar discectomy for all types of lumbar disc herniations (LDH) including severely difficult and extremely difficult LDH cases. Pain Physician ;21:E401-8.

32. Kim HS, Yudoyono F, Paudel B, et al. Suprapedicular circumferential opening technique of percutaneous endoscopic transforaminal lumbar discectomy for high grade inferiorly migrated lumbar disc herniation. Biomed Res Int ;:.

33. Osman SG, Nibu K, Panjabi MM, et al. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine (Phila Pa ) ;22:-5.

34. Lewandrowski KU. Incidence, management, and cost of complications after transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis: a value proposition for outpatient ambulatory surgery. Int J Spine Surg ;13:53-67.

35. Sairyo K, Higashino K, Yamashita K, et al. A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: technical considerations in a fresh cadaver model and a literature review. J Med Invest ;64:1-6.

36. Yeung A, Roberts A, Zhu L, et al. Treatment of soft tissue and bony spinal stenosis by a visualized endoscopic transforaminal technique under local anesthesia. Neurospine ;16:52-62.

37. Lewandrowski KU. Endoscopic transforaminal and lateral recess decompression after previous spinal surgery. Int J Spine Surg ;12:98-111.

38. Yagi K, Kishima K, Tezuka F, et al. Advantages of revision transforaminal full-endoscopic spine surgery in patients who have previously undergone posterior spine surgery. J Neurol Surg A Cent Eur Neurosurg Dec 5 doi: 10./a-- . [Epub].

39. Telfeian AE, Sastry R, Oyelese A, et al. Awake, transforaminal endoscopic lumbar spine surgery in octogenarians: case series. Pain Physician ;25:E255-62.

40. Lee JS, Kim HS, Jang JS, et al. Structural preservation percutaneous endoscopic lumbar interlaminar discectomy for L5- S1 herniated nucleus pulposus. Biomed Res Int ;:.

41. Ruetten S, Komp M, Godolias G. A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg ;49:80-7.

42. McGrath LB, White-Dzuro GA, Hofstetter CP. Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. J Neurosurg Spine Jan;11:1-9. doi: 10./.9.SPINE . [Epub].

43. Ruetten S, Komp M, Merk H, et al. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine ;10:476-85.

44. Lee CH, Choi M, Ryu DS, et al. Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis. Spine (Phila Pa ) ;43:-64.

45. Hua W, Liao Z, Chen C, et al. Clinical outcomes of uniportal and biportal lumbar endoscopic unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective pair-matched case-control study. World Neurosurg ;161:e134-45.

46. Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus ;46:E9.

47. Kim HS, Wu PH, Sairyo K, et al. A narrative review of uniportal endoscopic lumbar interbody fusion: comparison of uniportal facet-preserving trans-Kambin endoscopic fusion and uniportal facet-sacrificing posterolateral transforaminal lumbar interbody fusion. Int J Spine Surg ;15(Suppl 3):S72-83.

48. Kang MS, Heo DH, Kim HB, et al. Biportal endoscopic technique for transforaminal lumbar interbody fusion: review of current research. Int J Spine Surg ;15(Suppl 3):S84-92.

49. Wu PH, Kim HS, Lee YJ, et al. Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling preparation technique for symptomatic foraminal stenosis secondary to severe collapsed disc space: a clinical and computer tomographic study with technical note. Brain Sci ;10:373.

50. Heo DH, Park CK. Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurg Focus ;46:E18.

51. Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg ;34:E64-71.

52. Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J ;21:-77.

Additional resources:
What Are the Advantages of lower limb prosthesis for sale？

With competitive price and timely delivery, Lingchuang Yihui sincerely hope to be your supplier and partner.

53. Heo DH, Lee DC, Kim HS, et al. Clinical results and complications of endoscopic lumbar interbody fusion for lumbar degenerative disease: a meta-analysis. World Neurosurg ;145:396-404.

54. Ruetten S, Komp M, Merk H, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa ) ;33:940-8.

55. Guo L, Wang J, Zhao Z, et al. Microscopic anterior cervical discectomy and fusion versus posterior percutaneous endoscopic cervical keyhole foraminotomy for single-level unilateral cervical radiculopathy: a systematic review and metaanalysis. Clin Spine Surg ;36:59-69.

56. Ma W, Peng Y, Zhang S, et al. Comparison of percutaneous endoscopic cervical keyhole foraminotomy versus microscopic anterior cervical discectomy and fusion for single level unilateral cervical radiculopathy. Int J Gen Med ;15:-907.

57. Clark JG, Abdullah KG, Steinmetz MP, et al. Minimally invasive versus open cervical foraminotomy: a systematic review. Global Spine J ;1:9-14.

58. Lin Y, Rao S, Li Y, et al. Posterior percutaneous full-endoscopic cervical laminectomy and decompression for cervical stenosis with myelopathy: a technical note. World Neurosurg Jan;12:S-(19)-8. doi: 10./j.wneu..12.180 . [Epub].

59. Kim J, Heo DH, Lee DC, et al. Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien) ;163:-43.

60. Ahn Y. Endoscopic spine discectomy: indications and outcomes. Int Orthop ;43:909-16.

61. Ahn Y, Keum HJ, Shin SH. Percutaneous endoscopic cervical discectomy versus anterior cervical discectomy and fusion: a comparative cohort study with a five-year follow-up. J Clin Med ;9:371.

62. Zhang J, Zhou Q, Yan Y, et al. Efficacy and safety of percutaneous endoscopic cervical discectomy for cervical disc herniation: a systematic review and meta-analysis. J Orthop Surg Res ;17:519.

63. Zhu C, Deng X, Pan H, et al. Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis. Acta Neurochir (Wien) ;164:-33.

64. Zhu C, Wang J, Cheng W, et al. Case report: bilateral biportal endoscopic open-door laminoplasty with the use of suture anchors: a technical report and literature review. Front Surg ;9:.

65. Lvov I, Grin A, Kordonskiy A, et al. Minimally invasive posterior transarticular stand-alone screw instrumentation of C1-C2 using a transmuscular approach: description of technique, results and comparison with posterior midline exposure. World Neurosurg ;128:e796-805.

66. Kotheeranurak V, Pholprajug P, Jitpakdee K, et al. Full-endoscopic anterior odontoid screw fixation: a novel surgical technique. Orthop Surg ;14:990-6.

67. Faciszewski T, Winter RB, Lonstein JE, et al. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of procedures. Spine (Phila Pa ) ;20:-9.

68. Sundaresan N, Shah J, Foley KM, et al. An anterior surgical approach to the upper thoracic vertebrae. J Neurosurg ;61:686-90.

69. Choi KY, Eun SS, Lee SH, et al. Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg ;53:25-8.

70. Cheng XK, Chen B. Percutaneous endoscopic thoracic decompression for thoracic spinal stenosis under local anesthesia. World Neurosurg ;139:488-94.

71. Shen J, Telfeian AE. Fully endoscopic 360° decompression surgery for thoracic spinal stenosis: technical note and report of 8 cases. Pain Physician ;23:E659-63.

72. Jia ZQ, He XJ, Zhao LT, et al. Transforaminal endoscopic decompression for thoracic spinal stenosis under local anesthesia. Eur Spine J ;27:465-71.

73. Kang MS, Chung HJ, You KH, et al. How i do it: biportal endoscopic thoracic decompression for ossification of the ligamentum flavum. Acta Neurochir (Wien) ;164:43-7.

74. Mayberg MR, LaPresto E, Cunningham EJ. Image-guided endoscopy: description of technique and potential applications. Neurosurg Focus ;19:E10.

75. Sommer F, Goldberg JL, McGrath L Jr, et al. Image guidance in spinal surgery: a critical appraisal and future directions. Int J Spine Surg ;15(s2):S74-86.

76. Rawicki N, Dowdell JE, Sandhu HS. Current state of navigation in spine surgery. Ann Transl Med ;9:85.

77. Habib N, Filardo G, Distefano D, et al. Use of intraoperative CT improves accuracy of spinal navigation during screw fixation in cervico-thoracic region. Spine (Phila Pa ) ;46:530-7.

78. Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa ) ;37:891-900.

79. Hecht N, Yassin H, Czabanka M, et al. Intraoperative computed tomography versus 3D C-Arm imaging for navigated spinal instrumentation. Spine (Phila Pa ) ;43:370-7.

80. Scarone P, Vincenzo G, Distefano D, et al. Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients. J Neurosurg Spine ;29:397-406.

81. Fan G, Wang C, Gu X, et al. Trajectory planning and guided punctures with isocentric navigation in posterolateral endoscopic lumbar discectomy. World Neurosurg ;103:899-905.e4.

82. Hur JW, Kim JS, Cho DY, et al. Video-assisted thoracoscopic surgery under O-arm navigation system guidance for the treatment of thoracic disk herniations: surgical techniques and early clinical results. J Neurol Surg A Cent Eur Neurosurg ;75:415-21.

83. Hahn BS, Park JY. Incorporating new technologies to overcome the limitations of endoscopic spine surgery: navigation, robotics, and visualization. World Neurosurg ;145:712-21.

84. Gong J, Huang X, Luo L, et al. Radiation dose reduction and surgical efficiency improvement in endoscopic transforaminal lumbar interbody fusion assisted by intraoperative Oarm navigation: a retrospective observational study. Neurospine ;19:376-84.

85. Quillo-Olvera J, Quillo-Resendiz J, Quillo-Olvera D, et al. Ten-step biportal endoscopic transforaminal lumbar interbody fusion under computed tomography-based intraoperative navigation: technical report and preliminary outcomes in Mexico. Oper Neurosurg (Hagerstown) ;19:608-18.

86. Wu J, Ao S, Liu H, et al. Novel electromagnetic-based navigation for percutaneous transforaminal endoscopic lumbar decompression in patients with lumbar spinal stenosis reduces radiation exposure and enhances surgical efficiency compared to fluoroscopy: a randomized controlled trial. Ann Transl Med ;8:.

87. Wu B, Wei T, Yao Z, et al. A real-time 3D electromagnetic navigation system for percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a retrospective study. BMC Musculoskelet Disord ;23:57.

88. Ghaednia H, Fourman MS, Lans A, et al. Augmented and virtual reality in spine surgery, current applications and future potentials. Spine J ;21:-25.

89. Yuk FJ, Maragkos GA, Sato K, et al. Current innovation in virtual and augmented reality in spine surgery. Ann Transl Med ;9:94.

90. Jamshidi AM, Makler V, Wang MY. Augmented reality assisted endoscopic transforaminal lumbar interbody fusion: 2-dimensional operative video. Oper Neurosurg (Hagerstown) ;21:E563-4.

91. Molina CA, Theodore N, Ahmed AK, et al. Augmented reality-assisted pedicle screw insertion: a cadaveric proof-ofconcept study. J Neurosurg Spine Mar;29:1-8. doi: 10./.12.SPINE . [Epub].

92. Zheng C, Li J, Zeng G, et al. Development of a virtual reality preoperative planning system for postlateral endoscopic lumbar discectomy surgery and its clinical application. World Neurosurg ;123:e1-8.

93. Gao S, Wei J, Li W, et al. Accuracy of robot-assisted percutaneous pedicle screw placement under regional anesthesia: a retrospective cohort study. Pain Res Manag ;:.

94. Wang Z, Tan Y, Fu K, et al. Minimally invasive trans-superior articular process percutaneous endoscopic lumbar discectomy with robot assistance. BMC Musculoskelet Disord ;23:.

95. Heo DH, Kim JY, Park JY, et al. Clinical experiences of 3-dimensional biportal endoscopic spine surgery for lumbar degenerative disease. Oper Neurosurg (Hagerstown) ;22:231-8.

96. Kim SK, Bendardaf R, Ali M, et al. Unilateral biportal endoscopic tumor removal and percutaneous stabilization for extradural tumors: technical case report and literature review. Front Surg ;9:.

97. Wang T, Yu H, Zhao SB, et al. Complete removal of intraspinal extradural mass with unilateral biportal endoscopy. Front Surg ;9:.

The purpose of this paper is to review the data supporting current endoscopic surgical techniques for the spine and the potential challenges and future of the field. The origins of endoscopic spine surgery can be traced back many decades, with many important innovations throughout its development. It can be applied to all levels of the spine, with many robust trials supporting its clinical outcomes. Continued clinical research is needed to explore its expanding indications. Although the limitations of starting an endoscopic program can be justified by its cost effectiveness and positive societal impact, challenges facing its widespread adoption are still present. As more residency and fellowship programs include endoscopy as part of their spine training, it will become more prevalent in hospitals in the United States. Technological advancements in spine surgery will further propel and enhance endoscopic techniques as they become an integral part of a spine surgeon&#;s repertoire.

1. Brief History of Endoscopic Spine Surgery

Approaches for the surgical management of spinal pathology, including disc herniations and spinal stenosis, have evolved significantly since the first lumbar discectomy was described in [1]. The effort to develop minimally invasive tools and techniques to minimize tissue damage and improve visualization has evolved throughout the history of modern surgery [2]. The evolution of open un-magnified surgery to microscopic surgery has progressed over the last century. Endoscopic approaches in spine surgery represent an advancement of these techniques. Endoscopes such as laparoscopes and cystoscopes have been used consistently in general surgery, urology, and otolaryngology. The utilization of endoscopes for spine surgery has been a more recent development in the latter half of the last century.

The origins of endoscopic approaches to the spine can be traced back to Hijikata and Kambin in the s. Parviz Kambin demonstrated a percutaneous approach for a lateral discectomy using a cannula in . In , Hijikata developed and used tubes to obtain posterolateral access to lumbar disc spaces. He coined this procedure a &#;percutaneous nucleotomy&#; [3]. These approaches at the time did not allow for the direct visualization of the spinal canal. The idea of endoscopic direct visualization was applied using a modified arthroscope by Forst and Hausman in the s and later by Kambin using an endoscope. Kambin described a safe anatomical triangular working zone for endoscopic approaches in [4].

A fully functional endoscopic system (visualization, tissue manipulation, and resection) was used by Anthony Yeung in the s for endoscopic transforaminal approaches [5]. This system used a multichannel, wide-angled endoscope with continuous saline irrigation and underwater bipolar dissection. Multiple endoscopic systems were being developed and utilized in several countries at that time. A description of the successful treatment of far lateral herniated discs using an endoscope through a tubular retractor was published in by Kevin Foley et al. [6]. A transforaminal approach using bone reamers to open the foraminal window was described in by Michael Schubert and Thomas Hoogland [7]. In the early s, Sebastian Ruetten applied the technology to interlaminar endoscopic approaches [1].

The continued development of endoscopic techniques has included the use of two separate channels, one working channel and one for the endoscope. This technique is generally termed endoscope-assisted surgery or the unilateral biportal endoscopic (UBE) technique. In , De Antoni described a UBE technique [8]. In addition to an interlaminar approach, a biportal extraforaminal endoscopic approach has also been described [9]. The UBE technique has been supported by good surgical results for the treatment of lumbar stenosis and disc herniation [10].

Today, endoscopic spinal surgery continues to make advances in equipment, techniques, and in the applications of its use. The development of endoscopic spine surgery has advanced significantly for the treatment of many spinal pathologies, but challenges to its widespread adoption remain.

If you want to learn more, please visit our website spinal rigid endoscope.