抄録
The purpose of endoscopic spine surgery is to be a simple minimally invasive alternative to conventional open surgery, and reduce the approach-related trauma without rib resection and long incision of uninvolved tissue. The surgical technique required newly-developed longer tools for the restricted access and new methods of visualizing, illuminating and magnifying the operative field.
The surgical technique of discectomy continues to be refined and improved in alternative and less invasive procedures. Recently, a laparoscopic approach for anterior interbody fusion at the lumbosacral level has been reported. But it may be technically difficult to access and decompress the spinal cord and spinal root involvement. A lateral approach based on the technique of Watkins, while providing excellent access to the root and extraforaminal disc, does not permit adequate visualization of the far-lateral extraforminal area from the posterior approach. To resolve this, we propose a novel lateral lumbar approach using retroperitonecoscopy for decompression of extreme lateral disc involvement, making a longitudinal separation between the psoas major and the quadratus lumborum. Another approach to the lateral lumbar spine is the foraminoscope of an arthroscope 4mm in diameter and 30°oblique scope using a 10-cc syringe and dilator. One enlarges the small space between the back muscles successively and inserts the syringe and makes a cavity with the dilator. This new approach is the most direct, efficient anatomical route to the lateral involvement of lumbar and lumbosacral spine and offers the advantages of minimally invasive surgery.
There were some minor but no major complications. This procedure provides adequate nerve decompression and fusion with clear visualization and minimal dissection of the abdominal muscles without surgical invasion to the paraspinal muscles and rib resection.
