Decompression for cervical disc herniation using the full-endoscopic anterior technique.

OBJECTIVE: Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach. INDICATION: Fresh disc herniation with monoradicular symptoms in the upper extremity. CONTRAINDICATIONS: Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity. SURGICAL TECHNIQUE: Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space. POSTOPERATIVE MANAGEMENT: Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6. RESULTS: A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.

[Decompression for cervical disc herniation using the full-endoscopic anterior technique - German version]. / Dekompression beim zervikalen Bandscheibenvorfall in vollendoskopischer, ventraler Technik.

OBJECTIVE: Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach. INDICATION: Fresh disc herniation with monoradicular symptoms in the upper extremity. CONTRAINDICATIONS: Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity. SURGICAL TECHNIQUE: Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space. POSTOPERATIVE MANAGEMENT: Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6. RESULTS: A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.

Full-endoscopic posterior foraminotomy surgery for cervical disc herniations.

OBJECTIVE: Surgery for cervical disc herniation with full-endoscopic posterior access. INDICATIONS: Cervical disc herniation and neuroforaminal pathology with radicular symptoms. CONTRAINDICATIONS: Neck pain alone, cervical myelopathy or pathologies with central nervous system symptoms, instabilities requiring correction/instabilities. SURGICAL TECHNIQUE: Introduction of a surgical tube to the facet joint at the level to be operated on. Resection of bony and ligamentous parts of the cervical spinal canal under endoscopic guidance. Visualisation of the disc herniation and decompression of the neural structures. POSTOPERATIVE MANAGEMENT: Immediate mobilisation, specific rehabilitative physiotherapy depending on pre-existing neurological deficits. RESULTS: A total of 87 patients underwent full-endoscopic posterior surgery and were followed over a period of 2 years. Significant improvement was observed. No serious complications occurred. In all, 5 patients underwent revision in the follow-up period. Of the patients, 93% would undergo the procedure again.

[Decompression of lumbar lateral spinal stenosis: full-endoscopic, interlaminar technique]. / Dekompression der lumbalen Rezessusstenose : Endoskopische, interlaminäre Technik.

OBJECTIVE: Decompression in lumbar recess stenosis in a full-endoscopic technique using an interlaminar approach. INDICATIONS: Lumbar recess stenosis due to ligamentous, osseous, discogenic compression, and/or juxta-facet cysts. CONTRAINDICATIONS: Pure back pain, instability/deformity requiring correction, pure foraminal stenosis. SURGICAL TECHNIQUE: Introduction of a surgical sleeve to the intralaminar window. Endoscopic resection of compressing bony/ligamentary structures and also of osteophytes or parts of annulus. POSTOPERATIVE MANAGEMENT: Immediate mobilization, isometric/coordination exercises, functional exercises from week 3, building up strength from week 6. RESULTS: A total of 192 patients underwent full-endoscopic surgery or microsurgery and were followed up over a minimum of 2 years. A significant improvement was revealed. Serious complications occurred in 5% and were significantly reduced in the endoscopic group. Five patients were revised with decompression and/or fusion. Eighty-nine percent would undergo the operation again.