Spine

Product

Procedure

El enfoque endoscópico de las discectomías interlaminares proporciona un acceso mínimamente invasivo a las hernias posteriores de la columna lumbar inferior a las que puede resultar difícil acceder mediante un abordaje transforaminal. Además, la discectomía interlaminar produce menos alteraciones tisulares y musculares, tiempos de recuperación más breves y un retorno y un retorno mas rápido a las actividades que los procedimientos de reparación abierta tradicionales.1-4 Los instrumentos endoscópicos WishBone™ ofrecen una sensación táctil y una ergonomía mejoradas que facilitan el uso invertido y retrógrado con cualquier manos.
Referencias
1. Matsumoto M, Hasegawa T, Ito M, et al. Incidence of complications associated with spinal endoscopic&nbsp;surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of&nbsp;Japanese&nbsp;Orthopaedic&nbsp;Association.&nbsp;Orthop&nbsp;Sci. 2010;15(1):92-96. doi:10.1007/s00776-009-1428-6​
2. Ahn Y, Oh HK, Kim H, Lee SH, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced&nbsp;surgical technique and clinical outcomes. Neurosurgery. 2014;75(2):124-133.&nbsp;doi:10.1227/NEU.0000000000000361
3.&nbsp;Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and&nbsp;foraminotomy for the treatment of lumbar spinal stenosis. J Orthop. 2013;10(1):13-16.&nbsp;doi:10.1016/j.jor.2013.01.006
4. Ruetten&nbsp;S,&nbsp;Komp&nbsp;M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: Full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J&nbsp;Neurosurg Spine 2007;6(6):521-530. doi:10.3171/spi.2007.6.6.2.​

This animation demonstrates the steps of the interlaminar approach for a discectomy procedure using the SynergyID™ imaging system and a spine-specific endoscope. It also highlights the unique WishBone™ instrument handle, which is designed for improved ergonomics, and FlexTip electrosurgery probe.

Not Hidden

English  - en

video

Human

Interlaminar Approach for Endoscopic Discectomy Procedures

Arthrex interlaminar endoscopic approach for a discectomy is an ultra minimally invasive surgery ideal for patients who have been diagnosed with a paracentral lumbar disc herniation. In this procedure, the endoscope is used to assist in the approach for access and visualization, place the patient in the prone position and use a c-arm to verify the correct level being treated. Using both AP and lateral images based on the preoperative MRI, use a six step approach to complete the procedure. Step one the bulls eye. Use a switching stick to identify the entry point, which is the lateral aspect of the ipsilateral interlaminar window. Make an incision between 8 to 10mm through both the skin and fascia. An alternative method utilizing serial dilators can also be used. Insert an introducer needle. Remove the stylet and pass a guidewire through the cannula and then remove the cannula. Insert serial dilators over the guidewire until the appropriate diameter is achieved. Continue utilizing dilators for steps two and three. Step two the click. Use fluoroscopy and insert the switching stick into the interlaminar window and on top of the ligamentum flavum. The tip of the switching stick is used to traverse the inferior edge of the lamina in a caudal to cranial direction. This action should create a tactile click, as the tip of the switching stick comes over the edge of the lamina. Insert the cannula over the switching stick, then remove the switching stick and insert the endoscope. The surgeon may choose to connect the cannula holder to aid in maintaining the trajectory. Connect the holder to the cannula prior to the switching stick being removed. A depth stop may be attached to the endoscope to maintain the depth within the cannula. Arthrex offers a unique WishBone handle design that allows for improved ergonomics and mobility of the instrument by the surgeon. Step three cleaning the trampoline. Once the endoscope has been inserted, insert a series of grasping instruments and the electrosurgery probe through working channel of the endoscope to remove excess tissue and coagulate blood vessels to expose the ligamentum flavum. Step four. The black hole. Use both the straight and angled scissor punch instruments to resect the ligamentum flavum, and to gain access to the spinal canal, which will present itself as the look of a black hole. This is caused by irrigation fluid moving into the spinal canal, creating negative pressure on the Carta equina, thereby expanding the epidural space. Step five. Identify the edge of the nerve root. Once a sufficient amount of ligament has been excised, slowly advance the cannula through ligament and into the spinal canal, with the bevel of the cannula facing medial and allowing the edge of the nerve root to be clearly visualized. Step six. Retract and protect. Mobilize the nerve root by using instruments such as a blunt tip, elevator nerve hook, and articulating probe to release any scar tissue that may be adhered to the dura. Once the nerve root has been mobilized, advance and rotate the cannula to retract and protect the nerve root. With the nerve root retracted and protected, use a blunt instrument, such as an elevator, to put pressure on the annulus, releasing the nucleus. Pulposus. Next, use grasping forceps to extract the exposed nuclear material. Use the Electrosurgery probe to ablate nuclear material and minimize the annular defect. Once complete, slowly remove the scope and cannula.

Sohrab Gollogly, MD (Monterey, CA), demonstrates the technique for accessing posterior disc herniations in the lower lumbar spine with the endoscopic interlaminar approach. This approach allows for less damage to the paraspinous musculature,1 faster recovery,2 and high-definition visualization of the pathological anatomy.
References
1. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931-939. doi:10.1097/BRS.0b013e31816c8af7
2. Franco D, Mouchtouris N, Gonzalez GA, et al. A review of endoscopic spine surgery: decompression for radiculopathy. Curr Pain Headache Rep. 2022;26(3):183-191. doi:10.1007/s11916-022-01017-x

Endoscopic Approach to Interlaminar Discectomy

My name is Doctor Saurabh Gallogly. I'm an orthopedic spine surgeon in Monterey, California, and today I am going to demonstrate an endoscopic posterior decompression of the lumbar spine at the l5-s1 level. To begin this procedure, we'll mark the incision on the skin with the use of fluoroscopy. So I'll position a dilator over the l5-s1 level and bring fluoroscopy in and take a single AP view. And once I've satisfied that I've got the center of this marker in the middle of the interlaminar window at the l5-s1 level, I'll make a dimple in the skin there. Once I've made the dimple in the skin, I'll use a 15 blade and make a sub one centimeter incision through the skin. Once I've made the incision through the skin, I'll go one layer deeper in order to be able to incise the fascia, which makes the passage of the dilator slightly easier. The next step, per my usual technique, is to take the dilator and in the vertical position, bring that dilator directly down onto the spine with a slight, slight twirling motion. Once I'm down at the level that I'm comfortable that I'm pushing on the ligamentum flavum, I'm able to tactilely confirm that I'm at the interlaminar window by feeling the click of the dilator on the trailing edge of the L5 lamina. This step is essential for me to be confident that I'm operating on the correct level and the correct location, and then I'll confirm that with fluoroscopy, by bringing the fluoroscopy in and taking a picture and seeing the tip of the dilator in the center of the interlaminar window as we see there. This cannula has an oval opening, and we'll position the oval opening towards the midline. Slide it down over the top of the dilator. Dock it in the interlaminar space and remove the initial tissue dilator. Once we're confident that the cannula is in the correct position, we bring the endoscope through the cannula and start visualizing the interlaminar window. And then we'll take a confirmatory X-ray to double check that we're operating on the correct level before taking fluoroscopy out of the surgical field. The first thing that we see inside the surgical field now is some loose fatty tissue on top of the interlaminar window. And we'll begin with the step of the operation that I call cleaning the trampoline. For this we use a bipolar cautery device. We'll insert that through the cannula and squeezing the trigger mechanism, direct the tip of the cautery towards the perimeter of the cannula, and we'll work our way around the perimeter of the cannula. Circumferentially in order to coagulate any bleeders that are coming across the surgical field. And what we're looking for here is just the removal of the last little bit of fat and fibrous tissue sitting on top of the ligamentum flavum, which once we start removing this will become apparent as a white layer in the center of the surgical field. To orient you to what we're looking at here, 12:00 is the midline of the spine. The patient's head is at 3:00 and the lateral recess and the facet complex is at 6:00. And then the caudal aspect of the spine is at 9:00. So after coagulating that the next step is to use the pituitary. Roger. And then we'll advance the cannula just slightly enough to be able to put the tissue of the ligamentum flavum under stretch. The next tool that we'll use is an endoscopic scissors. Using the straight endoscopic scissors, we'll slide those down the cannula. And to begin to snip our way through the ligamentum flavum looking for a surgical landmark called the black hole, which we see right there. The black hole is the beginning of the entry into the spinal canal, and we pause here for a moment to allow the endoscopic arrogant to flow through that, and to begin to push the dura and the nerve roots out of the way in anticipation of using now the up fighting endoscopic scissors to release the ligamentum flavum in the 6:00 direction to permit navigation around the edge of the nerve root. So here I've graphed a little bit of the Ligamentum flavum. The ligamentum flavum always releases with a very characteristic snip. And as I bite sequentially through the ligamentum flavum, I push my hands towards the 12:00 position as seen on the screen or towards the midline, with reference to the patient, and release more of the ligamentum flavum and the Ligamentous tissue in the lateral recess. We've advanced the cannula to the point that the remaining deep fibers of the ligamentum flavum are under tension, and with the up biting endoscopic scissors will release the last few remaining fibers towards the facet complex in the lateral recess. By navigating the endoscopic scissors around the ligamentum flavum and then snipping them with their very characteristic snip and click, we'll advance the cannula just a tiny little bit further into the opening that we've created. Going deeper inside the spinal canal. And the next step in the operation now is to safely identify the edge of the nerve root, to permit navigation around the nerve root towards the herniated or sequestered disc. Here we'll use an endoscopic grabber or a pituitary endoscopic pituitary Roger to remove some of the epidural fat. The epidural fat during endoscopy has a very glittery appearance. That is a reproducible landmark that confirms that we're operating inside the spinal canal. We're using an endoscopic pituitary Roger to remove epidural fat while looking to identify the edge of the S1 nerve route. This patient's got a very large interlaminar window. And here we can begin to see the edge of the S1 nerve route running from 3:00 to 9:00, surrounded by epidural fat and sitting on top of the l5 S1 disc. And we're now docked inside the spinal canal, lateral to the S1 nerve route on top of the L5 S1 disc. Here we can use an endoscopic freer elevator to mobilize the S1 nerve route in the medial to lateral plane by pulling from 12:00 to 6:00 with the cannula and wanding the endoscopic elevator underneath and to the lateral side of the S1 nerve route on top of the disc. And the white that we see now are the fibers of the annulus. Fibrosis of the l5 s1 disc space. At this point in the in the procedure, we've safely navigate our way into the spinal canal. We've identified the lateral edge of the S1 nerve route. We've mobilized the nerve root to free it from any adhesions between the nerve root and the site of the disc herniation. And now we can complete the final step, which is to twist the cannula protecting the nerve root out of the way and establishing the channel for discectomy. Here we're using the bipolar device to shrink the epidural fat and coagulate any vessels that are in the area of the intended discectomy. This particular bipolar device has a WishBone handle, which makes it ergonomically very pleasant to use while you're doing this procedure. And I'm using a foot pedal to control both the coagulate and ablate functions. And I personally find that I use coagulate most frequently. So in this stage of the procedure now I'll rotate the cannula. There's the S1 nerve route. The lateral edge beautifully demonstrated. Most of the epidural fat and tissue has been removed in the area of the intended discectomy. We can rotate this back and forth if we're able to deliver a sequestration at this point. We can remove herniated disc if we're planning on doing entering the annulus and performing a discectomy. This is a good time in the procedure to hook up the cannula holder. What I like about this cannula holder is that while the cannula holder is for the most part semi-rigid, I also have a certain degree of range of motion and freedom to wand the cannula back and forth in order to access different parts of the surgical field. With this now in position, I can rotate the cannula freely inside the cannula holder, and we can navigate our way through the annulus into the disc. So in this case we'll shrink the exterior of the annulus. And here we can use either the bipolar device to create a small sealed annular opening by pushing the trigger and just sliding down into the l5-s1 disc. That generally is my preferred method. But if there's a sequestration just underneath the skin here and a layer or two annular tissue on top. I'll use an endoscopic scissors to remove the last 1 or 2 layers of annulus. Once the annular Artemis has been established, we can now use the pituitary grasper to enter the disc and complete as much of a discectomy as is required for this patient's pathology. One of the advantages of endoscopic techniques is that there is a significant amount of freedom of range of motion to proceed medially. In many instances, I've been able to confirm with fluoroscopy that I'm able to get the cannula across the midline and remove disc material until I've satisfied that I've completed the discectomy. Once that's been done, I'll then rotate the cannula to visualize the nerve root sitting on top of the site of the discectomy. At this point in the procedure, I observe frequently that the nerve root is now pulsatile. Cerebrospinal fluid is a pulsatile fluid, and frequently at the beginning of the discectomy you'll observe that the nerve root Has filamentous adhesions between the edge of the nerve root and the site of the disc herniation, and at the conclusion of the procedure, after you've released those adhesions and completed a discectomy, the nerve root will be pulsatile, confirming that you've got an excellent decompression. The last step in the procedure is simply to remove the holder first. Once the cannula holder is safely out of the way, we can now make one final inspection to visualize the nerve root exiting out the foramen. Traversing across the site of the discectomy. Exiting out the foramen. Visualize that there are no further sites of compression and we'll simply remove the cannula. Observing very gratefully the amount of tissue that simply closes back over the site of the operation, leaving a small sub one centimeter incision in the skin to close with a single buried monocryl suture.

application/pdf

Endoscopic Spine

As a privately held company for more than 40 years dedicated to its mission of Helping Surgeons Treat Their Patients Better®, Arthrex has pioneered arthroscopic surgery technology with more than 20,000 revolutionary arthroscopic and orthobiologics products that allow surgeons to treat joint pathology in the least invasive way possible—as an outpatient procedure.
Arthrex helped evolve diagnostic arthroscopy to arthroscopic resection, then repair, and finally arthroscopic and MIS reconstructions with orthobiologic augmentation. We helped restore—not replace—joints and ligaments. We frequently use autografts and allografts instead of metal to anatomically reconstruct cartilage, bone, and soft tissues. We create less-invasive surgical options and orthobiologics to preserve anatomy without more invasive hardware and end-stage procedures.
Fast forward to 2023, when Arthrex is applying its accumulated experience and expertise to revolutionize endoscopic and orthobiologics procedures for the spine. Arthrex visualization options deliver endoscopic image quality never before seen by spine surgeons, opening the door to less-invasive endoscopic treatments supported by advanced instrumentation and unparalleled surgical skills training, all aimed at someday replacing open surgery and microscope use for many spine procedures.
Learn these endoscopic procedures and how to incorporate innovative orthobiologics solutions into spine procedures through an endoscopic spine-specific course—taught by experienced clinical specialists and incorporating hands-on cadaveric surgical skills programs—at Arthrex global headquarters in Naples, FL, or in one of our many labs located across the US and around the world.

Join the Endoscopic Spine Evolution

As an industry leader in medical education, Arthrex has developed a curriculum pathway to learning endoscopic approaches to spine. This pathway starts with medial branch transection, progresses to interlaminar discectomies for central disc herniations, and finishes with transforaminal discectomies for posterolateral disc herniations. In addition to this endoscopic spine-specific program, Arthrex offers individualized training for facility staff, coding and billing support, and patient education resources.

Endoscopic Approaches to Spine: The Curriculum Pathway

A Patient’s Guide to Endoscopic Lumbar Discectomy

Mazda Farshad, MD (Zurich, Switzerland), performs a posterior endoscopic foraminotomy at the C4-C5 level.

Cervical Foraminotomy

My name is Mazda Farshad from Zurich, Switzerland. We are performing a posterior endoscopic cervical foramina. The patient is positioned like for a standard posterior approach of the cervical spine. You can use a Mayfield frame to fixate the head. Fluoroscopy is positioned 90 degrees to the patient. This is cranial. This is caudal. So we start first by palpating the midline and drawing the midline. Once the midline is identified by palpation and the line is drawn, we make a lateral fluoroscopy shot to identify the level that we're aiming at here we're aiming at levels four five. So we want to aim towards the disc of the level that we're aiming at. That would be level four, five and 90 degree to the spine. We can then insert the needle. The needle should be inserted approximately one centimeter lateral to the midline. This will allow that later on we can have a nice view on the foramen. Now we want to aim a little bit higher. Approximately 2 to 3mm higher to be able to palpate the upper lamina. That would be the lamina number four here. Once we're happy we cut the skin and do. Skin incisions in a vertical direction from cranial to caudal. So that conversion to open surgery would be possible at any time. Once this is done, the K-wires is installed. Make sure that the K-wires is vertical to the floor 90 degrees. Otherwise, adjust the patient and the table. By Trendelenburg or anti Trendelenburg to achieve this position. After that the dilation is done. This can be done stepwise or directly using the switching stick already with the switching stick. You can palpate the upper lamina Over the switching stick, the canyon can be inserted. A fluoroscopy shot will verify that we're on the right level with the switching stick inside, the lamina is freed up from muscles by going from medial to lateral using the sharp edge of the cannula, then the switching stick can be removed. Now we see the position of the cannula aiming at the disc four five, where we want to be at in approximately 90 degree angle to the cervical spine. Once this is done, we could insert the endoscope. For purposes of visualization, we will now do an AP view. The AP view can be used if one is unsure about medial lateral position of the cannula. The endoscope can now be inserted. And make sure to control the cannula so that it doesn't move. And now the soft tissue can be removed with a large pituitary. So the soft tissue is removed and we start to see the upper lamina C4, the bone of the upper lamina. Here we remove a little bit more soft tissue and identify the lower lamina of C5. Here with the bipolar we can clean up the soft tissue nicely and palpate the upper and the lower lamina. So the upper lamina here the medial border the lower lamina. And then we start to identify a V form. This is the so-called V sign formed by the upper lamina and the lower lamina. And this is the entrance to the spinal canal. Here we already see the ligamentum flavum. So now we want to turn the V into a U by using the burr. I usually start with the upper lamina and then we go. We proceed to the lower lamina. Make sure to remove enough of the lower lamina. No pressure on the burr, but more on the cannula if you want to manipulate the position. So now we have removed the bone and converted the V to a U. A little bit of the upper lamina. More on the lower lamina so that actually the ligamentum flavum, the attachment is disconnected to the lamina. Here we see we are already in the spinal canal. And we can start dissecting the ligamentum flavum from caudally to cranially. Once we have disconnected the ligament from the lower lamina, we can use a kerrison to remove it in a stepwise fashion. Before that, you might want to go more lateral by removing more bone. So then we can change the view a bit to resect the ligamentum flavum. I use the kerosene for that. Make sure to turn the scope so that you verify that you're just removing ligament and nothing else. The aim is to visualize the lateral border of the dura. The best view to remove the flavum towards medial is from caudal to cranial, so you can turn your scope around 70 to 90 degrees to visualize the opening of the kerosene to be able to remove the flavum safely. The identification of the lateral border of the dura is extremely important in order to identify the nerve. Once we have identified the lateral border of the dura as seen here, we can basically glide up to the nerve root, and here the nerve root is identified here. We are now in the axilla of the nerve root. The same can be done from cranial to caudal. Identifying the shoulder of the nerve root as demonstrated here. So now we see the dura, the lateral border. The axilla of the nerve root at this condition would be accessible here. And the shoulder of the nerve root here we are pointing towards the foramen. So with the ball tip we can palpate also the pedicle. Here we are palpating nicely the pedicle of the lower vertebra which is c5 in our case. The ball tip can also be used to carefully palpate into the foramen. Once this is done the foramen can be visualized By turning the scope facing the foramen. Once the nerve root is identified, we have to look into the foramen. For that, we position our canal either on the upper or the lower lamina, and turn the cannula and the camera in order to visualize the nerve, as demonstrated here. So now we're looking into the foramen, and we can use our kerosene to remove some more bone. You can always turn your camera to be able to have a better look for verification of a full decompression. Use your ball tip to palpate along the nerve root. So here we have the nerve root and the foramen which is now freed up. This can be also visualized from another view looking how the cranially. Here again we have the lateral border of the dura. The axilla. And here we are in the foramen. And now I'm palpating all through the foramen, making sure that the foramen is fully free and the nerve is decompressed. Once the decompression is completed and you have verified that visually, and also by palpation, you can pull out your camera and your cannula and close the skin with 1 or 2 stitches. Posterior cervical endoscopic approaches allow decompression of the nerves by foramina or and or discectomy. This is not a beginner level surgery for endoscopy. It allows to avoid acdf in many cases, can usually be performed within 45 to 60 minutes in an outpatient setting.

Discectomía endoscópica interlaminar

Instrumentencontainer Wirbelsäulenendoskopie, groß

WishBone-Scherenstanze, aufwärts gewinkelt, 2.5 mm x 330 mm

Scissor Punch, Up Angled, 2.5 x 330mm, WB

Pinça tesoura perfurante, angulada para cima, 2.5 x 330 mm WB

Kerrison/Ball Tip Probe, handle, WishBone handle

Child (D)

Un abordaje transforaminal o paraespinal permite acceder a hernias-laterales lejanas. El uso de un endoscopio específico para columna minimiza el daño a los tejidos blandos, lo que da como resultado menor dolor posoperatorio. 1,2 Además, estudios demostraron que aproximadamente el 85 % de los pacientes sometidos a discectomía lumbar endoscópica retornaron a la actividad deportiva en tan solo 6 a 8 semanas.3,4
Referencias
1. Sairyo&nbsp;K, Matsuura T,&nbsp;Higashino&nbsp;K, et al. Percutaneous endoscopic lumbar&nbsp;discectomy for athletes. J Spine. 2013;S5(006):1-4. doi:10.4172/2165-7939.S5-006&nbsp;​
2. Sivakanthan&nbsp;S, Williams JR,&nbsp;Feroze&nbsp;AH, et al. Endoscopic spine surgery in&nbsp;athletes: case series and review of literature. World&nbsp;Neurosurg. 2021;145:702-707. doi:10.1016/j.wneu.2020.08.211
3. Polikandriotis&nbsp;JA, Hudak EM, Perry MW. Minimally invasive surgery through&nbsp;endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal&nbsp;stenosis. J&nbsp;Orthop. 2013;10(1):13-16. doi:10.1016/j.jor.2013.01.006
4. Ruetten&nbsp;S,&nbsp;Komp&nbsp;M, Merk H,&nbsp;Godolias&nbsp;G. Use of newly developed instruments&nbsp;and endoscopes: Full-endoscopic resection of lumbar disc herniations via the&nbsp;interlaminar and lateral transforaminal approach. J&nbsp;Neurosurg&nbsp;Spine.&nbsp;2007;6(6):521-530. doi:10.3171/spi.2007.6.6.2

This animation reviews the steps of the transforaminal approach for discectomy procedures, which uses the SynergyID™ imaging system and a spine-specific endoscope. It also highlights the unique WishBone™ instrument handle, which is designed for improved ergonomics, and FlexTip electrosurgery probe.

Transforaminal Endoscopic Discectomy

Arthrex ultra minimally invasive transforaminal endoscopic approach for a discectomy procedure utilizes an endoscope to assist for access and visualization. Place the patient in the prone position based on the preoperative MRI or CT. Use the c-arm to verify the correct level using both AP and lateral images. Mark a line through the center of the disk space. Mark the midline. Mark a line along the bottom of the contralateral pedicle to the top of the ipsilateral pedicle. Vertically, place the tip of the instrument anterior to the disc and perpendicular to the dorsal skin surface. Mark the instrument at the intersection. Using the distance marked on the instrument. In step four, mark that distance off of the midline on the skin. The incision location is where the line intersects with the pedicle line. Mark the incision. Insert an introducer needle while utilizing AP and lateral to ensure the needle avoids neural structures. Remove the stylet and place a guidewire. Use a scalpel to make an incision to accommodate the outer diameter of the dilators and cannula. Sequentially place dilators over the guidewire. Place the cannula with the orientation of the cannula opening toward the exiting nerve root. Depending on surgeon preference and the patient's anatomy, trephines and rasps can be used to remove bone to provide visualization and access for the endoscope. The cannula inserted and while maintaining the desired trajectory and depth. Connect the cannula holder and insert the endoscope with the depth stop in place. Insert a series of endoscopic tools, including graspers, the Electrosurgery probe, and others, through the working channel of the endoscope to remove excess tissue, coagulate blood vessels, and to provide visualization and access to the disc pathology. Arthrex offers a unique WishBone handle design that allows for improved ergonomics and mobility of the instrument by the surgeon. Upon visually identifying the herniation or disc fragments, apply downward pressure with the cannula over the annular defect. Use various graspers and endoscopic instruments for tissue removal and decompression of the affected neural elements. Use a hook and ball tip probe, along with direct visualization, to ensure all fragments have been removed and the discectomy and decompression are complete prior to the removal of the endoscope and cannula.

Discectomía endoscópica transforaminal

Kanüle, mit Elevatorspitze, 8 mm x 178 mm

Wirbelsäulenendoskop, 30°, 7 mm x 181 mm

Endoscópio para coluna 7.0 x 181 mm 30°

WishBone-Löffelzange, 2.5 mm x 330 mm

WishBone-Löffelzange, aufwärts gewinkelt, 2.5 mm x 330 mm

Pinça Cup Fórceps angulada para cima 2.5 x 330 mm, WB

Pinça Cup Fórceps angulada 2.5x330 mm WB

WishBone-Scherenstanze, 2.5 mm x 330 mm

Pinça tesoura perfurante 2.5 x 330 mm WB

The traditional open approach for treating far lateral disc herniations at L5-S1 is challenging. Alternatively, the transforaminal endoscopic approach lands directly at the far lateral zone and requires little or no facet resection to achieve decompression.

This animation reviews the lumbar transforaminal lateral discectomy procedure, which is performed with the Synergy Vision™ imaging system and a spine-specific endoscope. It also highlights the unique WishBone™ instrument handle, which is designed for improved ergonomics, and FlexTip electrosurgery probe.

Lumbar Transforaminal Lateral Endoscopic Approach for L5/S1 Discectomy

Arthrex ultra minimally invasive transforaminal endoscopic approach for an l5-s1 discectomy procedure utilizes an endoscope to assist for access and visualization. Place the patient in the prone position based on the preoperative MRI or CT. Use the c-arm to verify the correct level using both AP and lateral images. Mark a line through the center of the disc space. Mark the midline. Mark a line along the bottom of the contralateral pedicle to the top of the ipsilateral pedicle. Vertically, place the tip of the instrument anterior to the disc and perpendicular to the dorsal skin surface. Mark the instrument at the intersection. Using the distance marked on the instrument. In step four, mark that distance off of the midline on the skin. The incision location is where the line intersects with the pedicle line. Mark the incision. Insert an introducer needle while utilizing AP and lateral to ensure the needle avoids neural structures. Remove the stylet and place a guidewire. Use a scalpel to make an incision to accommodate the outer diameter of the dilators and cannula. Sequentially place dilators over the guidewire. Place the cannula with the orientation of the cannula opening toward the exiting nerve root. Depending on the surgeon preference, the patient's anatomy, trephines, rasps or burrs can be used to remove bone to provide visualization and access for the endoscope. The cannula inserted and while maintaining the desired trajectory and depth. Connect the cannula holder and insert the endoscope with the depth stop in place. Insert a series of endoscopic tools, including graspers, the electrosurgery probe, and others, through the working channel of the endoscope to remove excess tissue, coagulate blood vessels, and to provide visualization and access to the disk. Pathology. Arthrex offers a unique WishBone handle design that allows for improved ergonomics and mobility of the instrument by the surgeon. Upon visually identifying the herniation or disc fragments, apply downward pressure with the cannula over the annular defect. Use various graspers and endoscopic instruments for tissue removal and decompression of the affected neural elements. Use a hook and ball tip probe, along with direct visualization, to ensure all fragments have been removed and the discectomy and decompression are complete prior to the removal of the endoscope and cannula.

Discectomía lumbar

Discectomía endoscópica interlaminar

Discectomía endoscópica transforaminal

Endoscopic Far Lateral Transforaminal Lumbar Discectomy