Index 377 Index

A chymopapain patents and preparations, Alajouanine, T. H., 6 352, 353 Ancient medicine, management of back and Food and Drug Administration approval, leg pain, 1–3 352–354 Anesthesia, negative press, 355–357 microendoscopic discectomy, 364, 365 rationale, 351, 364 minimally invasive lumbar surgery, Chymodiactin, see Chemonucleolysis 75, 76 Chymopapain, percutaneous transpedicular discectomy, adjunctive therapy for disc herniations, 188 213, 351 X-Stop interspinous process distraction history of use, 351–357, 364 device, 320, 323 , pain management, 275 Annular debridement, arthroscopic, 123 Computed tomography (CT), Annular fenestration, historical perspective, 9 annular tear, 119, 121 Annular tear, pain diagnosis, 122 diagnosis, 122 lateral recess stenosis, 145 pain generation, 119–121 skin entry site selection for lumbar disc Annulus fibrosus, features, 42, 43, 45 herniation repair, 80 Antibiotics, prophylaxis, 76, 77 stereotactic imaging, see Frameless Aristotle, 1 stereotactic imaging Arthroscopes, posterolateral access, 50 transpedicular biopsy guidance, 175 Cotugno, Domenico, 3, 4 Arthroscopic microdiscectomy, see Lumbar Crouzon, O., 6–8 disc herniation CT, see Computed tomography Atavi®, comparison with other internal fixation D systems, 233, 234 Degenerative disc disease, see Intervertebral components, 230, 231 disc degeneration fixation systems, 232, 233 Disc fragment retrieval, FlexPosure® retractor, 230, 231, 235 historical perspective, 15, 21 MiCOR™ allograft block, 233 lumbar disc herniation repair, 91, 92 Avicenna, 1–3 Discectomy, see Lumbar disc herniation; B,C Microendoscopic discectomy; Percutaneous transpedicular Bozzini, P. D., 18 discectomy; Selective endoscopic C-arm, selection, 73 discectomy™ Cannulas, , postoperative prevention, 116 development , 17, 18 Dorsal root ganglion (DRG), lumbar disc herniation repair, anatomy, 31–33, 35 oval cannula positioning, 89, 90 vascularity, 160–163 placement, 81–83 DRG, see Dorsal root ganglion posterolateral access, 49 Dural sac, anatomy, 39 Capsular ligamentum flavum complex, Dyesthesia, see Skin hypersensitivity anatomy, 45 Chemonucleolysis, E Chymodiactin downfall factors, 354, Electromyography (EMG), neuromonitoring, 355, 357 214, 251 377 378 Index

EMG, see Electromyography imaging, 289 Endoscopy, injectate, 291 advantages, 252 needle techniques, 289–291 disadvantages, 252 overview, 289 endoscope features, 251 patient positioning, 289 historical perspective, 18, 19, 21–23 degeneration and pain generation, 121, lumbar transperitoneal and retroperitoneal 271, 272 spinal procedures, laser rhizotomy, 262, 263 outcomes, 256, 257 FlexPosure® retractor, see Atavi® overview, 254, 255 Foraminoplasty, laser, 212, 213, 263, 264 principles, 255, 256 Frameless stereotactic imaging, thoracoscopic spinal endoscopy, costs, 347 outcomes, 253, 254 image acquisition, 336, 337 overview, 252, 255 limitations, 347, 348 principles, 252, 253 overview, 335 Epidural adipose tissue, features, 38 presurgical planning, 337, 338 Epidural bleeding, prospects, 345, 346 complication prevention, 113 spinal surgery applications, 341–344, 348 control, 99, 100 stereotaxis principles, 335, 336 Epidural injection, surgical navigation systems, 338–340 caudal epidural, virtual fluoroscopy, 341 catheter delivery, 283, 284 G,H imaging, 282 injectate, 283 Growth factors, utilization in minimally needle techniques, 283 invasive posterior fusion and fixation, overview, 282 229, 230 patient positioning, 282 Herniation, see Lumbar disc herniation lumbar interlaminar epidural, Hijikata, S., 12, 17, 22, 205 complications, 282 Hippocrates, 1 imaging, 280, 281 I injectate, 282 needle techniques, 281 IDET, see Intradiscal electrothermal overview, 279, 280 coagulation patient positioning, 280 Infection, prevention, 76, 77, 116 lumbar transforaminal epidural, Interlaminar access, minimally invasive imaging, 276–278 surgery, 59 injectate, 279 Intervertebral disc degeneration, needle techniques, 278 diagnosis, 122 nerve avoidance, 279 epidemiology, 295 overview, 276 history of study, 4, 359 patient positioning, 276 pain generation, 119, 295 steroid injection technique, 272–274 treatment, Evocative chromodiscography™, see expandable cage introduction, 123 Selective endoscopic discectomy™ nuclear replacement, see Nucleus replacement F overview, 295, 296 Facet joint, prosthetic disc implantation, 296 anatomy, 271 Intracanalicular ligaments, anatomy, 39 block, Intradiscal electrothermal coagulation duration of relief, 291 (IDET), indications and principles, 364 Index 379

K,L discitis, 116 Kyphoplasty, infection, 116 complications, 246 needle insertion, 109, 110 outcomes, 244–246 power-driven suction nuclear resectors, overview, 240, 242 113 technique, 242–244 skin hypersensitivity, 114–116 vertebroplasty comparison, 247 intradiscal electrothermal coagulation, 364 Lasers, magnetic resonance imaging, 359, 363 facet rhizotomy, 262, 263 microendoscopic discectomy, foraminoplasty, 212, 213, 263, 264 anesthesia, 364, 365 invention, 259 complications and prevention, medicine applications, 259 371.373, 374 percutaneous laser discectomy, 259–262 discectomy, 369 selective endoscopic discectomy™, 212, outcomes, 374 213 patient positioning, 365 sympathectomy, 264–267 prospects, 374, 375 Lateral recess stenosis, see also Spinal soft tissue removal, 367–369 stenosis surgical approach, 365–367 clinical presentation, 145, 146 wound closure, 369, 371 diagnosis, 145 minimally invasive surgery technique, history of study, 135 anesthesia, 75, 76 surgical management, annulotomy, 87, 88 outcomes, 147 antibiotic prophylaxis, 76, 77 overview, 147 C-arm, 73 skin hypersensitivity and management, cannulas, 147–149 oval cannula positioning, 89, 90 Lazarevic test, lumbar disc herniation, 61–63 placement, 81–83 Low , see Pain disc fragment retrieval, 91, 92 Lumbar disc herniation, fluid management, 92–95 arthroscopic and endoscopic disc surgery foraminal and extraforaminal advantages, herniation retrieval, 95–97 complication minimization, instrument lodging site selection, 81 epidural scarring, 67, 68 needle positioning, 77, 79 nerve root damage, 67, 68 operating room table, 70–73 cost-effectiveness, 70 paramedial or central disc herniation documentation, 68 retrieval, 98 epidural venous system protection, 68 patient positioning, 73, 75 paraspinal muscle integrity radiographic landmarks, 81 maintenance, 68 radiolucent frame, 73 postoperative imaging, 68 recurrent disk herniation retrieval, 107, reherniation risks, 66 108 spinal stability maintenance, 68 sequestered disc herniation retrieval, visualization, 66 98–101, 104–106 chemonucleolysis, 364 skin entry site selection, 79–81 clinical features and diagnosis, 61, 63, surgical site identification, 77 65, 66, 360–362 thoracic or thoracolumbar herniation complications and prevention, retrieval, 107 cannulas, triangular working zone examination, migration, 112, 113 83, 86, 87 placement, 110, 112 physical examination, 362, 363 380 Index

M vascular supply of intradural roots, 157, Magnetic resonance imaging (MRI), 158 annular tear, 121, 221 Nuclear mass reduction, intervertebral disc pain diagnosis, 122, historical perspective, 9, 11, 12, 14 221, 359 pain reduction outcomes, 123 lateral recess stenosis, 145 Nucleus pulposus, lumbar disc herniation, 359, 363 anatomy, 41 stereotactic imaging, see Frameless replacement, see Nucleus replacement stereotactic imaging Nucleus replacement, MED, see Microendoscopic discectomy historical perspective, 297 Medial branch, hydrogel polymers, block, cadaveric endoscopic implantation and diagnostics, 287–289 biomechanical studies, 304–308 imaging, 287 ideal criteria, 298 injectate, 287 polyvinyl alcohol/ needle techniques, 287 polyvinylpyrrolidone hydrogel, overview, 286, 287 dissolution behavior, 299–302 patient positioning, 287 stability, 298–302 radiofrequency ablation, 272 stress relaxation and fatigue, MiCOR™ allograft block, see Atavi® 302–304 Microendoscopic discectomy (MED), prospects for study, 309, 310 types, 297, 298 anesthesia, 364, 365 intervertebral disc mechanics, 298 complications and prevention, 371.373, rationale in degenerative disc disease, 297 374 discectomy, 369 O outcomes, 374 Operating table, selection, 70–73 patient positioning, 365 Osteoporosis, see Vertebral compression prospects, 374, 375 fracture soft tissue removal, 367–369 surgical approach, 365–367 P wound closure, 369, 371 Pain, Minimally invasive spinal surgery, see also annular tear, 119–121 specific techniques, facet joint degeneration, 121 approaches, see Posterolateral access, inflammatory agents, 121 historical perspective, 18, 19, 21–23 intervertebral disc sources, 119 MRI, see Magnetic resonance imaging economic impact, 359 minimally invasive techniques in N management, Needles, caudal epidural, insertion complications, 109, 110 catheter delivery, 283, 284 positioning, 77, 79 imaging, 282 posterolateral access, 49 injectate, 283 Nerve root, needle techniques, 283 anatomy, 31–33, 35 overview, 282 damage minimization in arthroscopic and patient positioning, 282 endoscopic disc surgery, 67, 68 coccydynia, 275 dorsal root ganglion vascularity, 160–163 epidural steroid injection, 272–274 endoscopic neurolysis, 123 facet joint block, intradural supply of intradural roots, duration of relief, 291 155–157 imaging, 289 slow vs rapid compression effects, 160 injectate, 291 Index 381

needle techniques, 289–291 pyogenic spondylodiscitis, overview, 289 advantages, 196, 197, 200 patient positioning, 289 contraindications, 199, 200 lumbar interlaminar epidural, indications, 188 complications, 282 outcomes, 198, 199 imaging, 280, 281 technique, injectate, 282 anesthesia, 188 needle techniques, 281 phases, 191, 193, 196 overview, 279, 280 Steinmann pin, 189, 191 patient positioning, 280 Percutaneous vertebroplasty (PVP), lumbar transforaminal epidural, complications, 241, 242 imaging, 276–278 kyphoplasty comparison, 247 injectate, 279 outcomes, 241 needle techniques, 278 overview, 240, 241 nerve avoidance, 279 polymethyl methacrylate injection, 240, overview, 276 241 patient positioning, 276 Periannular bleeding, complication medial branch block, prevention, 113 diagnostics, 287–289 Posterior longitudinal ligamentum, anatomy, imaging, 287 45 injectate, 287 Posterolateral access, needle techniques, 287 bilateral biportal approach, 53–55, 100, overview, 286, 287 101 patient positioning, 287 instruments, 49, 50 radiofrequency medial branch ablation, interlaminar access, 59 272 unilateral biportal approach, 55, 58 sacrococcygeal joint injection, uniportal approach, 53 imaging, 291 Prosthetic discs, development, 123, 124 indications, 292 PVP, see Percutaneous vertebroplasty Pyogenic spondylodiscitis, injectate, 291 diagnosis, 180, 181 needle techniques, 291 management, overview, 291 overview, 183 patient positioning, 291 surgery, see Percutaneous sacroiliac joint block, transpedicular discectomy diagnostics, 286 natural history, 180, 181 imaging, 284–286 injectate, 286 Q–S needle techniques, 286 Queckenstedt maneuver, 151 overview, 284 Radiofrequency medial branch ablation, patient positioning, 284 technique, 272 sacroiliac joint steroid injection, Sacrococcygeal joint injection, 274, 275 imaging, 291 steroid therapy, 122 indications, 292 venous hypertension role, 153–155 injectate, 291 Paraspinal muscles, needle techniques, 291 anatomy, 29 overview, 291 integrity maintenance in arthroscopic and patient positioning, 291 endoscopic disc surgery, 68 Sacroiliac joint, Percutaneous transpedicular biopsy, see block, Transpedicular biopsy diagnostics, 286 Percutaneous transpedicular discectomy, imaging, 284–286 382 Index

injectate, 286 Yeung Endoscopic Spine Surgery system, needle techniques, 286 205, 207, 222 overview, 284 Skin hypersensitivity, patient positioning, 284 lateral recess stenosis surgery pain generation, 274, 284 complication and management, steroid injection, 274, 275 147–149 Safe zone, see Triangular working zone postoperative prevention, 114–116 , history of diagnosis and Somatosensory evoked potential (SSEP), management, 3–8 neuromonitoring, 214 Segmental instability, Spinal fusion, see Segmental instability classification, 124 Spinal instability, see Segmental instability definition, 124 , see also Lateral recess surgical stabilization, stenosis, arthroscopic anterior column anatomy, 315–317 stabilization augmented with clinical features, 315 percutaneously inserted history of study, 315 pedicular bolts and sc plates, treatment, applications, 141 overview, 317, 318 instruments, 126 X-Stop interspinous process outcomes, 142 distraction device, screw fixation of first sacral advantages, 327, 330 segment, 134–136, 138, 139, anesthesia, 320, 323 141 operative technique, 320, 322, 323 technique, 128–133 outcomes, 318, 319, 323–327 arthroscopic interbody fusion Spine anatomy, development, 125, 126 annulus fibrosus, 42, 43, 45 historical perspective, 124, 125 capsular ligamentum flavum complex, 45 indications, 124 dural sac, 39 minimally invasive posterior fusion epidural adipose tissue, 38 and fixation, intracanalicular ligaments, 39 Endius Atavi® system, see Atavi® nerve roots and ganglia, 31–33, 35 growth factor utilization, 229, 230 nucleus pulposus, 41 milestones, 227–229 paraspinal muscles, 29 thoracoscopic and laparoscopic posterior longitudinal ligamentum, 45 decompression and stabilization, thoracolumbar fascia, 29 142 triangular working zone, 29, 31 Selective endoscopic discectomy™, vasculature, 35–38, 151–153, 157, 158 chymopapain adjunctive therapy, 213 Spondylodiscitis, see Pyogenic electrothermal therapy, 209, 210 spondylodiscitis evocative chromodiscography™, SSEP, see Somatosensory evoked potential 207–209 Steroid therapy, exclusion criteria, 220 coccydynia, 275 foraminal epidurography and therapeutic epidural steroid injection, 272–274 injections, 216 perineural therapy, 122 historical perspective, 205, 206 sacroiliac joint steroid injection, 274, 275 imaging, 221 skin hypersensitivity management, 149 inclusion criteria, 217–219 transforaminal therapy, 122 indications, 217 Substance P, pain generation role, 121 lasers in foraminoplasty, 212, 213 Sympathectomy, laser, 264–267 neuromonitoring, 214–216 prospects, 221 T technique, 221–223 Thermal intradiscal therapy, principles, 124 Index 383

Thoracolumbar fascia, anatomy, 29 complications, 246 Transpedicular biopsy, outcomes, 244–246 anatomy, 172, 173 overview, 240, 242 complications, 174, 175 technique, 242–244 computed tomography guidance, 175 vertebroplasty comparison, 247 historical perspective, 167, 168 nonoperative management, 239 rationale, 167, 168, 174 percutaneous vertebroplasty, technique, 168, 170, 171 complications, 241, 242 Transpedicular discectomy, see kyphoplasty comparison, 247 Percutaneous transpedicular outcomes, 241 discectomy overview, 240, 241 Triangular working zone, polymethyl methacrylate injection, anatomy, 29, 31 240, 241 arthroscopic and endoscopic examination, prospects for management, 247, 248 83, 86, 87 Vertebroplasty, see Percutaneous identification for anchoring of vertebroplasty instruments, 15, 16 VIP, see Vasoactive intestinal polypeptide Triphens, posterolateral access, 49, 50 X V X-Stop interspinous process distraction Vasoactive intestinal polypeptide (VIP), pain device, generation role, 121 advantages, 327, 330 VCF, see Vertebral compression fracture anesthesia, 320, 323 Venous hypertension, operative technique, 320, 322, 323 animal experiment studies of venous outcomes in spinal stenosis, 318, 319, radiculomedullary circulation, 159, 323–327 160 neurogenic pain role, 153–155 Y slow vs rapid compression of nerve roots, YESS system, see Yeung Endoscopic Spine 160 Surgery system Vertebral compression fracture (VCF), Yeung Endoscopic Spine Surgery (YESS) epidemiology, 239 system, selective endoscopic kyphoplasty, discectomy™, 205, 207, 222