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Endoscopic spine procedures PDF

296 Pages·2011·22.443 MB·English
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K Endoscopic Spine Procedures i m / C h A lavishly illustrated, step-by-step o i guide to minimally invasive / L e endoscopic techniques for the spine e Endoscopic Spine Procedures combines the vast experience of internationally recognized E Daniel H. Kim n spine surgery experts and provides detailed coverage of operative techniques for the cervical, d thoracic, and lumbar spine. Gun Choi o s c Sang-Ho Lee The book begins with an overview of the principles of percutaneous endoscopic spine o surgery followed by a detailed discussion of applied anatomy, surgical approaches and p techniques, and potential complications for the different spine regions. Each chapter contains i c concise, step-by-step descriptions of the procedures enhanced by clearly labeled illustrations. S p i Features n • Bullet-point format enables rapid reference prior to surgery e • 12 high-resolution videos—one for every procedure described in the book—appear on an P r accompanying DVD o • 694 high-quality illustrations prepare readers for surgery, including radiographs, full-color c e endoscopic views, detailed drawings, and 3-D surgical views d • 29 clinical cases demonstrate how to tell the differences between spine levels and between u disease states r e s This concise technical guide is an essential resource for neurosurgeons, orthopedic surgeons, interventional radiologists, or anyone involved in the care of patients with spine disorders. Daniel H. Kim, MD, FACS, is Professor of Neurosurgery and Director of Spinal Neurosurgery and Reconstructive Nerve Surgery, Baylor College of Medicine, Houston, Texas. Gun Choi, MD, PhD, is President of Medical Affairs and Director of Endoscopic Spine Center, Wooridul Spine Hospital, Seoul, South Korea. Sang-Ho Lee, MD, PhD, is Chairman, Wooridul Spine Hospital, Seoul, South Korea. An award-winning international medical and scientific publisher, Thieme has demonstrated its commitment to the highest standard of quality in the state-of-the-art content and presentation of all of its products. Thieme’s trademark blue and silver covers have become synonymous with excellence in publishing. ISBN 978-1-60406-307-3 MediaCenter.thieme.com plus e-content online www.thieme.com Endoscopic Spine Procedures Endoscopic Spine Procedures Daniel H. Kim, MD Professor Director of Spinal Neurosurgery and Reconstructive Peripheral Nerve Surgery Baylor College of Medicine Houston, Texas Gun Choi, MD, PhD Attending Professor Hanyang Medical College President of Medical Aff airs Director of Endoscopic Spine Center Wooridul Spine Hospital Seoul, Korea Sang-Ho Lee, MD, PhD Chairman, Wooridul Hospital Group Seoul, Korea Thieme New York • Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Executive Editor: Kay Conerly Editorial Assistant: Lauren Henry Editorial Director, Clinical Reference: Michael Wachinger Production Editor: Grace R. Caputo, Dovetail Content Solutions International Production Director: Andreas Schabert Vice President, International Marketing and Sales: Cornelia Schulze Chief Financial Offi cer: James W. Mitos President: Brian D. Scanlan Compositor: Maryland Composition Printer: Everbest Printing Library of Congress Cataloging-in-Publication Data Endoscopic spine procedures / edited by Daniel H. Kim, Gun Choi, Sang-Ho Lee. p. ; cm. Includes bibliographical references. Summary: “As the understanding of human physiology has become more complete, the importance of preserving normal tissues has become increasingly clear in the fi eld of surgery. This understanding gave birth to the concept of minimally invasive surgery that has conquered almost all surgical fi elds, including spine surgery. With recent advances and experience, minimally invasive spinal surgery (MISS) is gradually replacing conventional spine surgical procedures. The primary goal of MISS is to achieve outcomes comparable to those of open surgery while minimi zing normal tissue damage and reducing recovery times. Advances in optics, radionavigation, and laser technology made MISS more accessible to surgeons and truly less invasive for the patient. Minimally invasive surgical techniques have touched the entire spinal column, from the cervical to the lumbosacral spine. The MISS spectrum ranges from simple disk surgeries to the most complicated spine surgeries, such as deformity correction. Of all MISS procedures, percutaneous endoscopic disk surgery has attracted the most attention from the global spine surgery community and has enjoyed phenomenal advances in sophistication in the past decade. The remainder of the chapter presents a historical account of percutaneous disk surgeries for the lumbar and cervical spine.”--Provided by publisher. ISBN 978-1-60406-307-3 1. Spine--Endoscopic surgery. I. Kim, Daniel H. II. Choi, Gun. III. Lee, Sang-Ho. [DNLM: 1. Spinal Diseases--surgery. 2. Endoscopy--methods. 3. Spine--surgery. 4. Surgical Procedures, Minimally Invasive--methods. WE 725] RD533.E535 2010 617.5’60597--dc22 2010028692 Copyright © 2011 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfi lms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their eff orts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confi rm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specifi c reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in China 978-1-60406-307-3 Contents Media Center Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Section I Principles and Essentials of Percutaneous Endoscopic Spine Surgery Chapter 1 History of Endoscopic Spine Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 2 Endoscopic Surgical Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Chapter 3 Operating Room Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Chapter 4 Selection and Use of Lasers and Their Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Chapter 5 Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Section II Percutaneous Endoscopic Cervical Diskectomy (PECD) Chapter 6 Applied Anatomy for Percutaneous Approaches to the Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Chapter 7 Surgical Techniques in Percutaneous Endoscopic Cervical Diskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Chapter 8 Case Presentations and Surgical Technique: Percutaneous Endoscopic Cervical Diskectomy . . . . . . . . . . . . .59 Chapter 9 Complications in Percutaneous Endoscopic Cervical Diskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Section III Percutaneous Endoscopic Thoracic Diskectomy (PETD) Chapter 10 Applied Anatomy and Percutaneous Approaches to the Thoracic Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 Chapter 11 Surgical Techniques in Percutaneous Endoscopic Thoracic Diskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Chapter 12 Case Presentations and Surgical Technique: Percutaneous Endoscopic Thoracic Diskectomy . . . . . . . . . . . . .82 Section IV Percutaneous Endoscopic Lumbar Diskectomy (PELD) Chapter 13 Applied Anatomy and Percutaneous Approaches to the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92 Chapter 14 Transforaminal Surgical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Chapter 15 Extraforaminal Surgical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 Chapter 16 Surgical Technique for Migrated Disk with Foraminoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 Chapter 17 Interlaminar Surgical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Chapter 18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy . . . . . . . . . . . . .143 Chapter 19 Case Presentations and Surgical Technique: Special Lumbar Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232 Chapter 20 Complications in Percutaneous Endoscopic Lumbar Diskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 v To access additional material or resources available with this e-book, please visit http://www.thieme.com/bonuscontent. After completing a short form to verify your e-book purchase, you will be provided with the instructions and access codes necessary to retrieve any bonus content. Media Center Information ■ 14 Transforaminal Surgical A pproach ■ 15 Extraforaminal Surgical Approach Case 1 Case 9 Percutaneous Endoscopic Cervical Diskectomy for Herni- Percutaneous Endoscopic Lumbar Diskectomy for Herni- ated Cervical Disk C5-6: Transforaminal Approach ated Lumbar Disk L3-4: Herniated Disk Fragment in Extra- foraminal Space Case 2 Percutaneous Endoscopic Thoracic Diskectomy for Herni- Case 10 ated Thoracic Disk T7-8: Transforaminal Approach Percutaneous Endoscopic Lumbosacral Diskectomy for Herniated Lumbar Disk L5-S1: Extraforaminal Disk Frag- Case 3 ment, Transforaminal Approach with Stiff Angle Percutaneous Endoscopic Lumbar Diskectomy for Herni- ated Lumbar Disk L2-3: Central Disk Fragment, Transfo- ■ 1 6 S urgical Technique for M igrated Disk raminal Approach with Foraminoplasty Case 4 Case 11 Percutaneous Endoscopic Lumbar Diskectomy for Herni- Percutaneous Endoscopic Lumbar Diskectomy for Herni- ated Lumbar Disk L3-4: Herniated Disk Fragment in Verte- ated Lumbar Disk L1-2: Upward-Migrated Disk Fragment, bral Foramen, Transforaminal Approach Transforaminal Approach Case 5 Case 12 Percutaneous Endoscopic Lumbar Diskectomy for Herni- Percutaneous Endoscopic Lumbar Diskectomy for Herni- ated Lumbar Disk L4-5: Paramedian Disk Fragment, Trans- ated Lumbar Disk L4-5: Central Downward-Migrated Disk foraminal Approach Fragment, Transforaminal Approach Case 6 Case 13 Percutaneous Endoscopic Lumbar Diskectomy for Herni- Percutaneous Endoscopic Lumbar Diskectomy for Recur- ated Lumbar Disk L4-5: Central Disk Fragment, Transfo- rent Herniated Lumbar Disk L4-5: Paramedian Disk Frag- raminal Approach ment, Transinterlaminar Approach and Transforaminal Approach with Osseous Process (Foraminoplasty) Case 7 Percutaneous Endoscopic Lumbar Diskectomy for Upward- Case 14 Migrated Disk L3-4: Foraminal Disk Fragment, Transforam- Percutaneous Endoscopic Lumbar Diskectomy for Lumbar inal Approach with Caudally Positioned Skin Entry Point Disk L5-S1: Paramedian Transforaminal Approach for L5-S1 with Endoscopic Drilling of Superior Articular Process Case 8 Percutaneous Endoscopic Lumbar Diskectomy for Highly Case 15 Migrated Lumbar Disk L4-5: Paramedian Disk Fragment Percutaneous Endoscopic Lumbar Diskectomy for Upward- with Highly Upward Migration, Transforaminal Approach Migrated Lumbar Disk L5-S1: Transforaminal Approach with Caudally Positioned Skin Entry Point from Contralateral Side vii viii DVD-ROM Contents ■ 17 Interlaminar Surgical Approach Case 18 Percutaneous Endoscopic Lumbosacral Diskectomy for Case 16 Herniated Lumbar Disk L5-S1: Paramedian Disk Fragment; Percutaneous Endoscopic Lumbosacral Diskectomy for Iliac Crest Is Not High, Therefore Translaminar Approach; Herniated Lumbar Disk L5-S1: Paramedian Disk Fragment, Combination Decompression for Shoulder and Axillary Transinterlaminar Approach Portion of Root Case 17 Case 19 Percutaneous Endoscopic Lumbosacral Diskectomy for Percutaneous Endoscopic Lumbar Diskectomy for Down- Herniated Lumbar Disk L5-S1: Downward Migration with ward Migrated Lumbar Disk L4-5 Left and L5-S1 Right: Multiple Fragments, Translaminar Approach, Combina- L5-S1 Interlaminar Approach for Migrated L4-5 and L5-S1 tion Decompression for Shoulder and Axillary Portion (Wide Interlaminar Space L5-S1), No Compression at L4-5 of Root Disk Level, Axillary Downward-Migrated Disk Foreword Spine surgery is the third most common operative area Endoscopic Spine Procedures is a fundamental addition and is growing faster than procedures on either the eye or to the fi eld of minimally invasive spine surgery. Its com- the heart. Costs are high, complications are frequent, and bination of historical overview, general considerations, even when outcomes are good, the period of disability af- and detailed descriptions of specifi c procedures avail- ter surgery is substantial. The future for spinal surgery is in able today provides an excellent basis for anyone who minimally invasive techniques. For the past 20 years, the wishes to practice these minimally invasive procedures. magnitude of spinal surgical procedures has been increas- The detailed approaches to the cervical, thoracic, and ing. Now, however, we will see a reversal of that trend, and lumbar diskectomies are all very useful to anyone wish- spinal surgical procedures are likely to become increasingly ing to learn or perfect the techniques. These diskectomy less invasive. This book is unique in its emphasis on the techniques are the most advanced of all the minimally minimally invasive approach to the correction of signifi cant invasive spine procedures, and all are best performed spinal disease. All spinal surgeons will do well to learn the with an endoscope. This book provides an excellent ba- lessons contained herein and begin the process of adding sis for learning these techniques for the spine surgeon minimally invasive procedures to their armamentarium. who wishes to do more than simple diskectomy. And this Endoscopic Spine Procedures will also be of value to those is only the beginning. There are many new minimally who recommend surgical procedures and who will need to invasive procedures for decompressing and stabilizing know the less invasive alternatives to standard operations. the spine. There is a strong possibility that other groups of spe- We all need to understand minimally invasive spine cialists will develop these minimally invasive skills outside surgery. This book presents what is most advanced in the spine surgery. Related procedures are being performed by fi eld while it gives readers an appreciation for what else is interventional radiologists, anesthesiologists, and pain possible. It also serves as a basis for understanding a bur- medicine specialists. Many minimally invasive procedures geoning area of spine surgery that will become dominant are likely to develop outside the specifi c confi nes of spinal in the future. Every spine surgeon who reads Endoscopic surgery specialists. Spine Procedures will do so to great advantage. Donlin M. Long, MD, PhD Distinguished Service Professor of Neurosurgery, Emeritus Founder, Department of Neurosurgery The Johns Hopkins University School of Medicine Baltimore, Maryland ix

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