The International Society for the Advancement of Spine Surgery in Boca Raton, FL USA | April 12 – April 14, 2017.
INTRODUCTION
Central disc herniations in the lumbar spine are difficult to access. Even with the so called “minimally invasive” techniques, substantial bone removal needs to occur which increases the likelihood of instability and failed back surgery syndrome in the long run.
We use a double, “nano” approach with an endoscope which produces no-access trauma to the normal spine in order to treat the pathology. The first access targets the center of the disc and provides decompression, the second access is more lateral and almost 90 degrees perpendicular to the A-P axis of the vertebral unit and targets specifically the herniated portion of the disc whether it is contained or extruded. The “offending” disc material is removed with the use of microtools. Because the second access is in close proximity to the abdominal cavity, it is essential to request a “full body thickness” CT through the affected levels in order to determine the safety of the access.
MATERIAL AND METHODS
A retrospective analysis from 2002 was performed by one of the authors. A total of 107 patients were gathered; 66% males and 34 % females, ages ranging 12 to 83 years old. There were 65 L4/5, 34 L5/S1 and 8 L3/4 herniations; 66% were contained and 34% extruded. The average f/u was 9 weeks. The results were reported utilizing the MacNab criteria.
RESULTS
No access limitation was showed on wide view CT scans. Results were as follows: Excellent: 52.33% (n=56), Good: 38.31% (n=41), Fair: 8.41% (n=9) and Poor: 0.95% (n=1) with an overall success rate of 90.64%. No complications were reported.
CONCLUSIONS
The term “minimally invasive” is very often used too liberally and with disregard for the actual changes the surgical procedure imposes on the normal spine. In that sense our “nano” procedure is the only minimally invasive spine procedure available today that causes no access trauma to the spine. This concept is specially true regarding central disc herniations because of their difficult access. Our technique is highly successful, very safe and avoids the deleterious long term effects of considerable bone removal and tissue dissection that may lead to failed back surgery syndrome.