Intervertebral foraminoscopy technology began to be used in the United States in 1999 and has rapidly attracted the attention of the global spine surgery community and gained wide recognition in a short period of time because of its many advantages, including high safety, ultra-minimally invasive, precision, visualization, rapid recovery, broad indications and low recurrence rate. Over the past decade or so, this technology has made amazing progress and has become recognized as the leading method for minimally invasive treatment of disc herniation.
The Rationale for Intervertebral Foraminoscopy
Initially, the surgeon needed to remove the laminae posteriorly, distracting the spinal cord and nerves to expose the herniated disc and remove it to remove its backward compression of the nerve roots. For a long time, this procedure was the only surgical method for treating lumbar disc herniation. However, removal of the disc inevitably destabilized the spine, while extensive stripping of muscles and ligaments, intraoperative nerve strain, interference with the spinal cord, bleeding and scar formation caused considerable problems for patients and surgeons.
With the development of minimally invasive techniques and the accumulation of surgical experience, minimally invasive spine surgery has begun to gradually replace traditional spine surgery. The primary goal of minimally invasive surgery is to achieve the results of open surgery while minimizing damage to normal tissues and shortening postoperative recovery time. However, the protruding disc “hides” in a tight cap of bone and a large pile of important nerve tissue, making it almost impossible to safely “straighten out” the disc in a minimally invasive manner.
In 1990, Kambin, an American medical doctor, discovered a “secret” passage between these nerves and the bones that led straight to the intervertebral disc, which he called the safety triangle. This discovery was like a back door for surgeons to open, so that surgical instruments can smoothly pass through this “secret” channel straight to the lesion, to safely remove the herniated disc without removing the bone and damaging the surrounding nerves, “straight to the dragon “It is no longer a luxury, so intervertebral foraminoscopy technology was born.
The high-flying intervertebral foraminoscopy system
Intervertebral foraminoscopy is the integration of a light source, camera device, and surgical instruments in a cigarette-thick rigid tube that reaches the intervertebral disc through the safety triangle on the posterior lateral side of the spine. The camera device provides a magnified, high-definition view similar to a microscope, and directly removes the herniated disc tissue under direct vision for the purpose of nerve root decompression.
Through more than a decade of development, a standardized set of surgical instruments and operating techniques has now been developed for laminectomy. Discectomy and decompression have become more and more mature, from the original wide range of central discectomy to more precise targeted nucleus pulposus resection, and safety and efficacy have been greatly improved.
Advantages of intervertebral foraminoscopy
1.Ultra-minimally invasive
Only a small percutaneous incision of 1cm is required, and a fine channel of 7mm in diameter is implanted through the lateral intervertebral foramen approach, avoiding interference with the spinal canal and nerves by traditional posterior surgery, without biting off the vertebral plates and joints, without destroying the paravertebral muscles and ligaments, without the need for built-in objects, and without impact on spinal stability.
2.Small scars
The surgical incision is small, so the postoperative skin scars are very small and do not affect the appearance. The most crucial thing is that the scar tissue at the discectomy site is much smaller than that of traditional surgery, and no scar will be formed in the spinal canal, with light neural adhesions and few sequelae.
3.Significant effect
Targeted technology, precise treatment, visualized operation, patients can feel obvious relief of symptoms during surgery, and the surgical effect is consistent with the gold standard of disc surgery – microscopic discectomy.
4.High safety
Local anesthesia operation, which can interact with the patient during the operation without injuring the nerves and blood vessels; operation under direct vision of the endoscope, with a clear surgical field of view, which greatly reduces the risk of operation.
5.Less complications
The operation is less traumatic, with low risk of forming blood clots and infection; postoperative scarring will not be left at the posterior important structures, causing adhesions of the spinal canal and nerves; there is no nerve root pulling during the operation, and the symptoms of numbness of the lower limbs do not appear or appear lightly after the operation.
6.Fast recovery
Generally, you can start to move on the ground 3 hours after surgery, and you can take care of your own urine and stool, and the care is simple. On average, it takes 3 to 6 weeks after surgery to resume daily life and physical exercise.
7.Wide range of indications
Able to deal with almost all types of disc herniation, some spinal stenosis, foraminal stenosis, calcification and other bony lesions.
8.Wide range of extension
The use of special radiofrequency electrodes under the scope can repair the ruptured fibrous ring, block the annular nerve fibers and treat discogenic pain. Combined with percutaneous fixation technology, the fusion and fixation of spinal slippage and instability can be completed in a minimally invasive manner; this basic platform can also be extended to cervical disc endoscopic surgery.