Lumbar disc herniation and spinal canal stenosis (lumbar spinal stenosis) are common in the community; are diseases that cause serious disruptions in the patient's quality of life
What is Lumbar Hernia and Spinal Canal Stenosis?
Lumbar hernia (lumbar disc herniation) and spinal canal stenosis (lumbar spinal stenosis) are common in society; are diseases that cause serious disruptions in the patient's quality of life. Lumbar hernia is the compression of the spinal cord and nerves coming out of the spinal cord when the gel-like disc between the vertebrae flexes outward due to the loads on it or by tearing the hard outer shell and protruding a part of it.
Due to this pressure, severe pain, loss of strength and sensation occur in the leg where the nerve reaches. Spinal canal stenosis is the narrowing of the spinal canal through which nerve structures pass due to the thickening of the bone structure, joints and ligaments in the spine over time. In this case, the spinal cord, nerve roots and vessels feeding these nerves are compressed, causing symptoms. Complaints of pain and fatigue in the legs occur with walking short distances.
Radiological imaging supporting neurological examination findings is very important in the diagnosis of herniated disc and lumbar canal stenosis. Diagnosis is made by direct radiographs, tomography, MR.
If necessary, the diagnosis is supported by electromyography (EMG).
What are the Treatment Methods for Lumbar Hernia and Spinal Canal Stenosis?
% of Patients 95 of them benefit from conservative treatment methods such as medication, rest, physical therapy and epidural injection(3). If these treatments fail, instrumentation for microdiscectomy, decompression and fusion are surgical methods that have been used for many years. However, minimally invasive methods are increasingly used as an important alternative due to various risks and complications associated with these surgical methods. Minimally invasive surgical methods, the most important application form of which is endoscopic surgery, provide advantages such as less postoperative pain, early healing, less adhesion and scar tissue formation, and better cosmetic appearance. Although endoscopic approaches in herniated disc surgery have been developed since the 1980s, the last It is applied in the treatment of spinal canal stenosis in the past.
Thus, full endoscopic disc surgery has become the most important minimally invasive surgical treatment option as an alternative to traditional methods.
How is Full Endoscopic Disc Surgery Performed?
Advanced in full endoscopic disc surgery Technological surgical instruments are used. A 25° angled endoscope is used to increase the field of view during surgery.
Thus, a better view of the operating field is provided. The optical part is formed from lenses and air gaps arranged in series to create the most suitable image. The working cannula is 7.9 mm in diameter and has the functions of protecting the endoscope from hard movements, helping hand movements and providing root retraction with its conical tip structure.
Cold light source is used for illumination. Contamination of the tip of the endoscope with blood is prevented by performing saline flushing at a certain pressure continuously during the operation and optimal vision is provided. Irrigation of the surgical site is also necessary for the operation of the high-power radiofrequency (RF) probe used for bleeding control. In this way, the surgical procedure is completed almost without bleeding. Almost all instruments used in classical surgical methods are designed in accordance with the structure of the endoscope.
A skin incision of approximately 5-10 mm is sufficient in full endoscopic disc surgery. Small skin incision provides advantages such as low infection risk, no wound healing problem, as well as aesthetic advantages. The 7.9 mm diameter working cannula delivered to the target allows the surgical procedure to be completed with minimal tissue damage, resulting in an almost painless post-operative recovery. Endoscopic disc surgery can also be applied to all lumbar hernia patients for whom traditional surgical treatment is decided. In full endoscopic disc surgery, two different methods are applied according to the characteristics of the hernia.
Transforaminal Method
In this technique, unlike conventional surgical methods, it is performed by entering 15-20 cm from the midpoint of the waist.
During the operation, the position of the surgical instruments is controlled by X-ray imaging of the continuous C-arm fluoroscopy device. In the spine, the nerve roots called foramen come out. The disc is reached by entering from the crocheted area. Thus, surgical dissection is not performed on any of the bones, muscles and ligaments and spinal stabilization is preserved. The herniated disc pressing on the nerve root is removed and the surgical procedure is completed. Despite all these advantages, the transforaminal endoscopic method has disadvantages such as the anatomical features of the spine and pelvis, and the inability to reach the hernia when disc hernias extend up and down. Interlaminar endoscopic technique has been developed as a solution to these limitations.
Interlaminar Method
In this technique, the space between the vertebrae is increased by bending the waist of the patient lying in the prone position on the operating table. The working cannula is sent to the target by entering through a 5-10 mm skin incision from the midline.
First, there is the ligament called flavum. With a specially developed scissors, the flavum is cut without damaging the nerves just below it. The disc and nerve roots are defined in detail with the use of high resolution 25 degree angle camera and lighting. After that, the nerve root is excised and the hernia is removed.
Full Endoscopic Spinal Canal Stenosis Surgery
Classical surgical treatment of spinal canal stenosis is the removal of the thickened bone, ligament and joint structures in the stenosis segment to the spinal cord and spinal cord. It is the removal of the pressure on the nerve roots. Since taking the posterior elements of the spine so wide leads to spinal slippage, stabilization must be ensured by attaching screws to the spine. In the classical method, the operation incision is large; This means increased tissue trauma, prolonged surgery time, risk of infection and prolonged recovery time. With endoscopic narrow canal surgery, the pressure on the nerves can be removed without disturbing the stabilization of the spine. In this way, the patient can heal in a short time and painlessly without a permanent implant in his body. With the high-speed drill specially designed for the endoscope, only the parts of the spine that press on the nerves are removed and the pressure is removed without impairing the stability of the spine. When the patients who were operated with a maximum of 1 cm incision instead of a large skin incision were discharged 1 day later; walking without pain associated with the surgical procedure They return to their normal lives in a short time with increased pain.
Advantages of Full Endoscopic Disc and Narrow Canal Surgery
Advantages of full endoscopic spine surgery; It can be summarized as a small incision, less tissue trauma and blood loss, less scar tissue formation after surgery, less need for painkillers, shorter recovery time, and no instability. It is an additional advantage that the patients are discharged on the same day or the next day if the treatment of canal stenosis was performed. The disadvantages are; It can be summarized as the necessity of using instruments that require advanced technology and high cost investment, the need for experienced and trained surgeons, and the inability to use them in patients with instability.
Read: 20
