PERSPECTIVES FOR VIDEO-ASSISTED SPINAL SU RGERY

Advances in spinal surgery for both posterior procedures on herniated discs and anterior procedures involving the vertebral body have been g reatly affected by developments in video-assisted techniques, Many of the procedures mentioned here are still in the development stage, othe rs have proven their efficacy, Discoscopy, achieved by introducing the endoscope via a posterolateral route into the intervertebral disc, ca n be used for diagnosis and treatment of the disc and the end plates, Other techniques exploring the spinal canal are also being developed, With miniaturization, these techniques will undoubtedly be predominant in the near future. The anterior route is facilitated at the thoracic level by the pleural cavity, Current indications for anterior endosco pic spinal surgery are limited to cord compression syndromes, but pers pectives for trauma or tumor surgery as web as reconstruction surgery for malformations in children are quite promising. On the lumbar level , surgery involving the lombo-sacral disc is the main indication for t ransperitoneal endoscopy, The risks (sepsis, occlusion, gas emboli) ca nnot be overlooked, but few complications have been observed to date, The retroperitoneal route can be used to approach the anterolateral as pect of the spine, particularly useful for the upper lumbar bodies, A third possibility is the extraperitoneal anterior route for video-assi sted procedures from L2-L3 to L5-S1, Although video-assisted procedure s have not yet been shown to improve long-term outcome after spinal su rgery, the immediate post-operative period is greatly simplified, a po int which may be of particular importance depending on the patient's g eneral status.