Introduction
To demonstrate effective transforaminal endoscopic microdecompression for
herniated lumbar discs, junctional disc herniations, spinal spondylosis and spinal stenosis.
This is to be accomplished with endoscopic micro spinal instruments, laser application, and
newly developed endoscopic decompression instruments (including SMART endoscopic lumbar spinal
tubular retractors, large cannulae, more aggressive trephines, curettes, rasps, and ronguers),
in addition to laser application.
Material and Methods
3421 herniated lumbar discs in 200 patients. Average age of 44.2 (24 to 92)
with symptomatic lumbar single and multiple herniated intervertebral discs. Each failed at
least 12 weeks of conservative care. Post operative follow up 6 mos to 72 mos (average 42 mos).
2 types of endoscopic systems are used: 1) For posterior paramedium endoscopic assisted
microdecompression of herniated lumbar discs and spinal stenosis, the SMART TM Endoscopic
Lumbar Spine System, a progressive gradual serial of endoscopic assisted tubular retractors with
appropriate sized dilators and more aggressive saw-toothed trephines, and laser are utilized for
laser thermodiskoplasty (LTD) for reshaping and tightening disc tissue further; 2) For
posteriorlateral transforaminal approach, the foraminoscopes are utilized. Again laser
application is also included for LTD.
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Results
There is no postoperative mortality, and had morbidity of less than 1%, in 2000 patients.
For single level, 94% of patients had good or excellent results, 6% had some residual symptoms though
improved overall, and 3% of patients did not improve significantly. A newly devised larger and more aggressive
endoscopic assisted tubular microdecompressive discectomy instrument set (SMART lumbar system), safely and
efficaciously allows wider and more complete removal of large or recurrent disc protrusions, scar tissue, bony
spurs, and spinal stenosis that cause nerve root compression, while protecting the adjacent nerve
root.
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The posteriorlateral transforaminal approach with a foraminoscope system allows a minimal
approach to the foramen and lumbar discs for spinal stenosis decompression and microdiscectomy. Laser
thermodiskoplasty reshapes (SB reshaped?) and tightened disc tissue further for decompression.
Conclusion
Transforaminal endoscopic laser microdecompression can effectively decompress herniated
lumbar discs and spinal stenosis, and perform foraminoplasty for lateral and central spinal stenosis. This
minimally invasive endoscopic technique aided by new instruments and laser application (LTD), provides a
safe and effective modality to achieve results in effective decompression of lumbar discs and spinal
stenosis, preserves spinal motion and provides a channel for spinal arthroplasty.
Learning Objective
The presentation provides the information for participants familiar with Transforaminal
Endoscopic Microdecompression for Lumbar Disc and Stenosis and Their Avoidance: 1. Recognize the surgical
indications. 2. The surgical technique. 3. Potential complications and avoidance.
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