Similar to a spinal endoscope, an intervertebral foramoscope is a light-equipped tube that enters the intervertebral foramen from the side or side and back of the patient’s body (either in a flat or oblique fashion) and performs the procedure in a safe working triangle. The surgery is performed outside the disc’s fibrous annulus, and the herniated nucleus pulposus, nerve roots, dural sac and hyperplastic bone tissue can be clearly seen under direct endoscopic vision. The herniated tissue is then removed using various types of grasping forceps, the bone is removed microscopically, and the broken fibrous annulus is repaired with radiofrequency electrodes.
The surgical trauma is small: the skin incision is only 7mm, just like the size of a soybean grain, bleeding is less than 20ml, and only 1 stitch is needed after surgery. It is completely different from the conventional open disc nucleus pulposus removal surgery, with many advantages of small incision, less bleeding, clear vision, safer operation, less postoperative pain and faster recovery, and at the same time, it achieves or even exceeds the efficacy of conventional open surgery.
1.Working principle
Intervertebral foraminoscopy is a minimally invasive spinal surgery system that removes the nerve root pressure and eliminates the pain caused by nerve compression by completely removing the herniated or prolapsed nucleus pulposus and hyperplastic bone outside of the intervertebral foramen safety triangle and disc fiber ring. While the herniated or prolapsed nucleus pulposus is completely removed, osteophytes are removed to treat spinal stenosis, and the broken annulus fibrosus can be repaired using radiofrequency technology.
2.Eight advantages
One: Minimally invasive. The lateral approach avoids interference with the spinal canal and nerves, and has no effect on spinal stability.
Two: direct purpose. Any herniated disc fragment can be removed.
Three: Wide range of indications. Can deal with almost all types of herniated discs, some spinal stenosis, foraminal stenosis, calcification and other lesions.
IV: Low complications. Little trauma, no scarring at important structures after surgery leading to adhesions of the spinal canal and nerves.
V: High safety. Local anesthesia, basically no bleeding, clear surgical field of view, and reduced risk of misoperation.
Six: fast recovery. The next day after surgery, you can go down to the ground and resume normal work and physical exercise in an average of 3-6 weeks.
Seven: High patient satisfaction. Immediate pain relief, simple care, outpatient access to surgery, and a skin incision of only 7 mm.
Eight: Wide range of extension. Artificial nucleus pulposus and artificial intervertebral disc can be performed.
3.Adapted to the population
The selection criteria for intervertebral foraminotomy or endoscopic microdiscectomy are not fundamentally different from those for laminectomy and disc removal. Patients with herniated discs selected for minimally invasive surgery must exhibit signs and symptoms of nerve root compression and must meet the following conditions.
1. persistent or recurrent radicular pain;
2. The radicular pain is more severe than the lumbar pain.
3. Strictly conservative treatment is ineffective. This includes the use of steroidal or non-steroidal anti-inflammatory pain medications, physical therapy, and occupational or condition training procedures. At least 4-6 weeks of conservative treatment is recommended, but if there is a progressive increase in neurological symptoms, immediate surgery is required;
4. No history of substance abuse or mental illness;
5, Positive straight leg raise test with difficulty bending;
6, In order to precisely determine the location and nature of the herniated or prolapsed nucleus pulposus, as well as the intervertebral foraminal osteophytes, a thorough imaging examination should be performed before surgery, especially CT and MRI are important means to precisely determine the size, location and nature of the nucleus pulposus.
4. Summary of experience
Percutaneous foraminoscopic technique can not only treat huge herniated, prolapsed and free disc herniation. Satisfactory treatment results can also be achieved for patients with special types of disc herniation and spinal stenosis, including recurrent disc herniation and degenerative slippage, but individualized design should be performed to select an appropriate treatment plan. Satisfactory treatment results can be achieved by carefully selecting the surgical approach according to the clinical manifestations.
For patients with unilateral limb symptoms, a single-segment or dual-segment approach is used based on neurolocalization signs; for patients with bilateral nerve root canal stenosis, a prone position with bilateral access or a unilateral access with bilateral decompression can be performed. The foraminoscopic technique is an effective method of treating recurrent lumbar disc herniation, avoiding the scar tissue formed posteriorly during the initial surgery and reducing the risk of dural sac tears and nerve injury. The working channel is obtained through a reaming drill, allowing direct removal of herniated discs and other compressed nerve tissue without disturbing the scar tissue and achieving direct visual decompression.
Foraminoscopic treatment can be considered in elderly patients with degenerative slipped spine (I°) without significant instability. Patients are characterized by advanced age, combination of other disorders or inability to tolerate open surgical treatment; after foraminoscopic enlargement of the nerve root canal, the patient’s postoperative neurological symptoms are eliminated and the outcome is satisfactory.