03-09 Part1.docVIP

Percutaneous Transforaminal Endoscopic Spine Surgery Anthony T. Yeung, MD Orthopaedic Surgeon DISC - Desert Institute for Spine Care Phoenix, AZ Christopher A. Yeung, MD Orthopaedic Surgeon DISC - Desert Institute for Spine Care Phoenix, AZ Endoscopic spine surgery is evolving rapidly due to improvements in surgical technique, endoscope design, and instrumentation. In an experienced surgeons hands, the endoscopic foraminal approach can be utilized for most lumbar disc herniations and for the diagnosis and treatment of degenerative conditions of the lumbar spine. The advantage of the foraminal endoscopic technique is the ability to reach, visualize, and treat intradiscal and foraminal pathologic lesions without destabilizing the posterior muscle column and facets. The learning curve is steep, but once mastered, the surgeon is able to reach any pathologic lesion in the foramen, including noncontained disc herniations, foraminal stenosis, foraminal osteophytosis, facet cysts, and annular tears. IntroductionWolfgang Rauschnings work illustrating the patho-anatomy of degenerative disc disease and degenerative conditions of the lumbar spine serves as a basis for treating pathologic findings with tissue-sparing, minimally invasive spine surgery. (1) Ideally, surgical interventional approaches should preserve normal anatomy and access the patho-anatomy without injuring normal tissue. The dorsal muscle column, if compromised as part of the surgical exposure, may be partly responsible for spinal instability and failed back surgery syndrome (FBSS). Due to the morbidity of the posterior surgical approach, disc surgery has traditionally been reserved for disc herniations causing radiculopathy or progressive nerve deficits from mechanical compression on the spinal nerves. This relatively conservative posture was due to the inherent morbidity of traditional posterior surgery that must violate and alter the important function of the muscles and facets of the posterior spina