Medical Presentations in 2009

Evolving Minimally Invasive Endoscopic Spine Surgery: A Surgeon’s Perspective and Technological Considerations

Author: John C. Chiu, M.D., FRCS, D.Sc, Director, Neurospine Surgery

Institution: California Spine Institute Medical Center, Thousand Oaks, CA, USA

Abstract: Degenerated lumbar disc and spinal stenosis are common problems requiring decompressive lumbar surgery. Open spinal discectomy is associated with significant morbidity, long-term convalescence, prolonged general anesthesia and wide dissection of tissues that can cause bleeding, scarring and eventual destabilization of spinal segments. The evolving less traumatic minimally invasive endoscopic lumbar decompression procedure is free from these potential complications. Therefore the pursuit of minimally invasive spine surgery (MISS) began.

This endoscopic spine surgical procedure, its surgical indications (for treatment of herniated lumbar discs, post fusion junctional disc herniation, neural compression, osteophytes, spinal stenosis, vertebral compression fractures, spinal tumor, synovial cysts and etc..), its operative techniques (both transforaminal endoscopic approach and interlamina endoscopic assisted approach) including tissue modulation technology (i.e. laser and radiofrequency surgical application) will be presented.

With increased utilization of complex high tech and digital technologies, and instruments in the surgical suite, it requires seamless connectivity to perform the surgical procedures, in a precise and orchestrated manner. SurgMatix®, a new integrated image-data based OR control system has been developed and utilized to facilitate this outpatient endoscopic spinal surgery. This system is designed to promote seamless integration of all aspects related to the surgical procedure and to reduce surgical time and personal requirement significantly. This ease to use SurgMatix® system creates organized control instead of organized chaos.

The surgical result has been extremely gratifying for both the patient and the surgeon. Among a series of 5336 MISS patients (10,255 discs). There was no postoperative mortality, and morbidity of less than 1%. However, the potential risk and potential complications will be discussed. Transforaminal endoscopic microdecompression can effectively decompress herniated discs and spinal stenosis with foraminoplasty for treatment of spinal stenosis. It also provides an excellent and effective access or platform for spine arthroplasty, spinal disk replacement, artificial disk, vertebralplasty, spinal fixation/fusion, disc re-growth technology and perhaps genome therapy. Obviously, this minimally invasive, less traumatic, outpatient endoscopic MISS treatment leads to excellent results, faster recovery, and significant economic savings.