History in endoscopic disc treatment

Biportal Approach for herniated disc tretament

(Arthroscopic Philosophy by Schreiber / Leu 1989)



The use of endoscopes on the uniportal posterolateral approach for the treatment of herniated discs soon showed its limitations. The simultaneous use of the endoscope and the instrument is not possible.

The next consideration of Schreiber / Leu was comparable, for example, to knee arthroscopy, using a bi-portale system

 
However, the anatomical conditions are so different that these considerations mean only a further intermediate step in the application of endoscopes in the intervertebral disc treatment. 

In knee arthroskopy the knee joint is brought to twice it´s size by means of a fluid to create a cavity were the optics and instrument could be used simultaneous. A sufficient image of the operation field for peroperative monitoring is delivered.
A similar procedure is not possible on the spine, because the magnification of the surgical field by using liquid in the same kind of knee arthroscopic procedure would damage the neural structures. Therefore, the sufficient viewing of the pathology is not possible. Because of surgical instrument design it is an intadiscal decompression operation technique.

Material and Methode: Two Operation canuals are positioned about 10 cm posterolateral on both sides of the spionsus by needle placement and blunt dilation. One operation canula of aprox. 14 cm length and 6 mm diameter is used for the instruments to remove the disk material, the other one for viewing with an Endoscope of 18 cm length and 4 mm diameter.

Progress: Simultaneous use of optics and surgical instruments