The evolution of percutaneous spinal endoscopy and discectomy: State of the art

Objective: The author relates his 7 years' experience with endoscopic spine surgery for lumbar disc herniations and conditions previously treated only with more invasive methods. Materials and Methods: Five hundred (500) patients were treated with the Ye ung endoscopic spine system, which features an endoscope with a 2.8 mm oper ating channel. The protocol included preoperative or intraoperative discogr aphy in all cases. Adjuvant therapies were employed in various clinical con ditions when dictated by the visualized spinal pathology - KTP laser (Laser scope, San Jose, CA) in 100 patients, radiofrequency by electrothermal prob e in 400 patients, chymopapain in 50 cases, and intraoperative steroids in 100 cases. A newer slotted tube system allowed for foraminoplasty and remov al of osteophytes or extruded fragments. Results: Good-to-excellent results were recorded in 432 of the 500 patients (86.4%). Separate analysis was made of the first 100 cases when the KTP la ser was in use. Conclusions: The 2.8 mm operating channel scope produced clear visualizatio n of annular tears, disc fragments, foraminal osteophytes, and the epidural space. Monitoring of the microinstruments in the disc space and spinal can al was readily accomplished. The quality of the imaging provided by discogr aphy improved the definition of the disc pathology Adjuvant use of lasers, radiofrequency, chymopapain, and intradiscal steroids and the newer slotted tube system, have contributed to the advances in minimally invasive techni que for endoscopic discectomy.