Index 377 Index A Alajouanine, T. H., 6 Ancient medicine, management of back and leg pain, 1 3 Anesthesia, microendoscopic discectomy, 364, 365 minimally invasive lumbar surgery, 75, 76 percutaneous transpedicular discectomy, 188 X-Stop interspinous process distraction device, 320, 323 Annular debridement, arthroscopic, 123 Annular fenestration, historical perspective, 9 Annular tear, diagnosis, 122 pain generation, 119 121 Annulus fibrosus, features, 42, 43, 45 Antibiotics, prophylaxis, 76, 77 Aristotle, 1 Arthroscopes, posterolateral access, 50 Arthroscopic microdiscectomy, see Lumbar disc herniation Atavi, comparison with other internal fixation systems, 233, 234 components, 230, 231 fixation systems, 232, 233 FlexPosure retractor, 230, 231, 235 MiCOR allograft block, 233 Avicenna, 1 3 B,C Bozzini, P. D., 18 C-arm, selection, 73 Cannulas, development, 17, 18 lumbar disc herniation repair, oval cannula positioning, 89, 90 placement, 81 83 posterolateral access, 49 Capsular ligamentum flavum complex, anatomy, 45 Chemonucleolysis, Chymodiactin downfall factors, 354, 355, 357 chymopapain patents and preparations, 352, 353 Food and Drug Administration approval, 352 354 negative press, 355 357 rationale, 351, 364 Chymodiactin, see Chemonucleolysis Chymopapain, adjunctive therapy for disc herniations, 213, 351 history of use, 351 357, 364 Coccydynia, pain management, 275 Computed tomography (CT), annular tear, 119, 121 intervertebral disc pain diagnosis, 122 lateral recess stenosis, 145 skin entry site selection for lumbar disc herniation repair, 80 stereotactic imaging, see Frameless stereotactic imaging transpedicular biopsy guidance, 175 Cotugno, Domenico, 3, 4 Crouzon, O., 6 8 CT, see Computed tomography D Degenerative disc disease, see Intervertebral disc degeneration Disc fragment retrieval, historical perspective, 15, 21 lumbar disc herniation repair, 91, 92 Discectomy, see Lumbar disc herniation; Microendoscopic discectomy; Percutaneous transpedicular discectomy; Selective endoscopic discectomy Discitis, postoperative prevention, 116 Dorsal root ganglion (DRG), anatomy, 31 33, 35 vascularity, 160 163 DRG, see Dorsal root ganglion Dural sac, anatomy, 39 Dyesthesia, see Skin hypersensitivity E Electromyography (EMG), neuromonitoring, 214, 251 377
378 Index EMG, see Electromyography Endoscopy, advantages, 252 disadvantages, 252 endoscope features, 251 historical perspective, 18, 19, 21 23 lumbar transperitoneal and retroperitoneal spinal procedures, outcomes, 256, 257 overview, 254, 255 principles, 255, 256 thoracoscopic spinal endoscopy, outcomes, 253, 254 overview, 252, 255 principles, 252, 253 Epidural adipose tissue, features, 38 Epidural bleeding, complication prevention, 113 control, 99, 100 Epidural injection, caudal epidural, catheter delivery, 283, 284 imaging, 282 injectate, 283 needle techniques, 283 overview, 282 patient positioning, 282 lumbar interlaminar epidural, complications, 282 imaging, 280, 281 injectate, 282 needle techniques, 281 overview, 279, 280 patient positioning, 280 lumbar transforaminal epidural, imaging, 276 278 injectate, 279 needle techniques, 278 nerve avoidance, 279 overview, 276 patient positioning, 276 steroid injection technique, 272 274 Evocative chromodiscography, see Selective endoscopic discectomy F Facet joint, anatomy, 271 block, duration of relief, 291 imaging, 289 needle techniques, 289 291 overview, 289 patient positioning, 289 degeneration and pain generation, 121, 271, 272 laser rhizotomy, 262, 263 FlexPosure retractor, see Atavi Foraminoplasty, laser, 212, 213, 263, 264 Frameless stereotactic imaging, costs, 347 image acquisition, 336, 337 limitations, 347, 348 overview, 335 presurgical planning, 337, 338 prospects, 345, 346 spinal surgery applications, 341 344, 348 stereotaxis principles, 335, 336 surgical navigation systems, 338 340 virtual fluoroscopy, 341 G,H Growth factors, utilization in minimally invasive posterior fusion and fixation, 229, 230 Herniation, see Lumbar disc herniation Hijikata, S., 12, 17, 22, 205 Hippocrates, 1 I IDET, see Intradiscal electrothermal coagulation Infection, prevention, 76, 77, 116 Interlaminar access, minimally invasive surgery, 59 Intervertebral disc degeneration, diagnosis, 122 epidemiology, 295 history of study, 4, 359 pain generation, 119, 295 treatment, expandable cage introduction, 123 nuclear replacement, see Nucleus replacement overview, 295, 296 prosthetic disc implantation, 296 Intracanalicular ligaments, anatomy, 39 Intradiscal electrothermal coagulation (IDET), indications and principles, 364
Index 379 K,L Kyphoplasty, complications, 246 outcomes, 244 246 overview, 240, 242 technique, 242 244 vertebroplasty comparison, 247 Lasers, facet rhizotomy, 262, 263 foraminoplasty, 212, 213, 263, 264 invention, 259 medicine applications, 259 percutaneous laser discectomy, 259 262 selective endoscopic discectomy, 212, 213 sympathectomy, 264 267 Lateral recess stenosis, see also Spinal stenosis clinical presentation, 145, 146 diagnosis, 145 history of study, 135 surgical management, outcomes, 147 overview, 147 skin hypersensitivity and management, 147 149 Lazarevic test, lumbar disc herniation, 61 63 Low back pain, see Pain Lumbar disc herniation, arthroscopic and endoscopic disc surgery advantages, complication minimization, epidural scarring, 67, 68 nerve root damage, 67, 68 cost-effectiveness, 70 documentation, 68 epidural venous system protection, 68 paraspinal muscle integrity maintenance, 68 postoperative imaging, 68 reherniation risks, 66 spinal stability maintenance, 68 visualization, 66 chemonucleolysis, 364 clinical features and diagnosis, 61, 63, 65, 66, 360 362 complications and prevention, cannulas, migration, 112, 113 placement, 110, 112 discitis, 116 infection, 116 needle insertion, 109, 110 power-driven suction nuclear resectors, 113 skin hypersensitivity, 114 116 intradiscal electrothermal coagulation, 364 magnetic resonance imaging, 359, 363 microendoscopic discectomy, anesthesia, 364, 365 complications and prevention, 371.373, 374 discectomy, 369 outcomes, 374 patient positioning, 365 prospects, 374, 375 soft tissue removal, 367 369 surgical approach, 365 367 wound closure, 369, 371 minimally invasive surgery technique, anesthesia, 75, 76 annulotomy, 87, 88 antibiotic prophylaxis, 76, 77 C-arm, 73 cannulas, oval cannula positioning, 89, 90 placement, 81 83 disc fragment retrieval, 91, 92 fluid management, 92 95 foraminal and extraforaminal herniation retrieval, 95 97 instrument lodging site selection, 81 needle positioning, 77, 79 operating room table, 70 73 paramedial or central disc herniation retrieval, 98 patient positioning, 73, 75 radiographic landmarks, 81 radiolucent frame, 73 recurrent disk herniation retrieval, 107, 108 sequestered disc herniation retrieval, 98 101, 104 106 skin entry site selection, 79 81 surgical site identification, 77 thoracic or thoracolumbar herniation retrieval, 107 triangular working zone examination, 83, 86, 87 physical examination, 362, 363
380 Index M Magnetic resonance imaging (MRI), annular tear, 121, 221 intervertebral disc pain diagnosis, 122, 221, 359 lateral recess stenosis, 145 lumbar disc herniation, 359, 363 stereotactic imaging, see Frameless stereotactic imaging MED, see Microendoscopic discectomy Medial branch, block, diagnostics, 287 289 imaging, 287 injectate, 287 needle techniques, 287 overview, 286, 287 patient positioning, 287 radiofrequency ablation, 272 MiCOR allograft block, see Atavi Microendoscopic discectomy (MED), anesthesia, 364, 365 complications and prevention, 371.373, 374 discectomy, 369 outcomes, 374 patient positioning, 365 prospects, 374, 375 soft tissue removal, 367 369 surgical approach, 365 367 wound closure, 369, 371 Minimally invasive spinal surgery, see also specific techniques, approaches, see Posterolateral access, historical perspective, 18, 19, 21 23 MRI, see Magnetic resonance imaging N Needles, insertion complications, 109, 110 positioning, 77, 79 posterolateral access, 49 Nerve root, anatomy, 31 33, 35 damage minimization in arthroscopic and endoscopic disc surgery, 67, 68 dorsal root ganglion vascularity, 160 163 endoscopic neurolysis, 123 intradural supply of intradural roots, 155 157 slow vs rapid compression effects, 160 vascular supply of intradural roots, 157, 158 Nuclear mass reduction, historical perspective, 9, 11, 12, 14 pain reduction outcomes, 123 Nucleus pulposus, anatomy, 41 replacement, see Nucleus replacement Nucleus replacement, historical perspective, 297 hydrogel polymers, cadaveric endoscopic implantation and biomechanical studies, 304 308 ideal criteria, 298 polyvinyl alcohol/ polyvinylpyrrolidone hydrogel, dissolution behavior, 299 302 stability, 298 302 stress relaxation and fatigue, 302 304 prospects for study, 309, 310 types, 297, 298 intervertebral disc mechanics, 298 rationale in degenerative disc disease, 297 O Operating table, selection, 70 73 Osteoporosis, see Vertebral compression fracture P Pain, annular tear, 119 121 facet joint degeneration, 121 inflammatory agents, 121 intervertebral disc sources, 119 low back pain economic impact, 359 minimally invasive techniques in management, caudal epidural, catheter delivery, 283, 284 imaging, 282 injectate, 283 needle techniques, 283 overview, 282 patient positioning, 282 coccydynia, 275 epidural steroid injection, 272 274 facet joint block, duration of relief, 291 imaging, 289
Index 381 needle techniques, 289 291 overview, 289 patient positioning, 289 lumbar interlaminar epidural, complications, 282 imaging, 280, 281 injectate, 282 needle techniques, 281 overview, 279, 280 patient positioning, 280 lumbar transforaminal epidural, imaging, 276 278 injectate, 279 needle techniques, 278 nerve avoidance, 279 overview, 276 patient positioning, 276 medial branch block, diagnostics, 287 289 imaging, 287 injectate, 287 needle techniques, 287 overview, 286, 287 patient positioning, 287 radiofrequency medial branch ablation, 272 sacrococcygeal joint injection, imaging, 291 indications, 292 needle techniques, 291 overview, 291 patient positioning, 291 sacroiliac joint block, diagnostics, 286 imaging, 284 286 injectate, 286 needle techniques, 286 overview, 284 patient positioning, 284 sacroiliac joint steroid injection, 274, 275 steroid therapy, 122 venous hypertension role, 153 155 Paraspinal muscles, anatomy, 29 integrity maintenance in arthroscopic and endoscopic disc surgery, 68 Percutaneous transpedicular biopsy, see Transpedicular biopsy Percutaneous transpedicular discectomy, pyogenic spondylodiscitis, advantages, 196, 197, 200 contraindications, 199, 200 indications, 188 outcomes, 198, 199 technique, anesthesia, 188 phases, 191, 193, 196 Steinmann pin, 189, 191 Percutaneous vertebroplasty (PVP), complications, 241, 242 kyphoplasty comparison, 247 outcomes, 241 overview, 240, 241 polymethyl methacrylate injection, 240, 241 Periannular bleeding, complication prevention, 113 Posterior longitudinal ligamentum, anatomy, 45 Posterolateral access, bilateral biportal approach, 53 55, 100, 101 instruments, 49, 50 interlaminar access, 59 unilateral biportal approach, 55, 58 uniportal approach, 53 Prosthetic discs, development, 123, 124 PVP, see Percutaneous vertebroplasty Pyogenic spondylodiscitis, diagnosis, 180, 181 management, overview, 183 surgery, see Percutaneous transpedicular discectomy natural history, 180, 181 Q S Queckenstedt maneuver, 151 Radiofrequency medial branch ablation, technique, 272 Sacrococcygeal joint injection, imaging, 291 indications, 292 needle techniques, 291 overview, 291 patient positioning, 291 Sacroiliac joint, block, diagnostics, 286 imaging, 284 286
382 Index injectate, 286 needle techniques, 286 overview, 284 patient positioning, 284 pain generation, 274, 284 steroid injection, 274, 275 Safe zone, see Triangular working zone Sciatica, history of diagnosis and management, 3 8 Segmental instability, classification, 124 definition, 124 surgical stabilization, arthroscopic anterior column stabilization augmented with percutaneously inserted pedicular bolts and sc plates, applications, 141 instruments, 126 outcomes, 142 screw fixation of first sacral segment, 134 136, 138, 139, 141 technique, 128 133 arthroscopic interbody fusion development, 125, 126 historical perspective, 124, 125 indications, 124 minimally invasive posterior fusion and fixation, Endius Atavi system, see Atavi growth factor utilization, 229, 230 milestones, 227 229 thoracoscopic and laparoscopic decompression and stabilization, 142 Selective endoscopic discectomy, chymopapain adjunctive therapy, 213 electrothermal therapy, 209, 210 evocative chromodiscography, 207 209 exclusion criteria, 220 foraminal epidurography and therapeutic injections, 216 historical perspective, 205, 206 imaging, 221 inclusion criteria, 217 219 indications, 217 lasers in foraminoplasty, 212, 213 neuromonitoring, 214 216 prospects, 221 technique, 221 223 Yeung Endoscopic Spine Surgery system, 205, 207, 222 Skin hypersensitivity, lateral recess stenosis surgery complication and management, 147 149 postoperative prevention, 114 116 Somatosensory evoked potential (SSEP), neuromonitoring, 214 Spinal fusion, see Segmental instability Spinal instability, see Segmental instability Spinal stenosis, see also Lateral recess stenosis, anatomy, 315 317 clinical features, 315 history of study, 315 treatment, overview, 317, 318 X-Stop interspinous process distraction device, advantages, 327, 330 anesthesia, 320, 323 operative technique, 320, 322, 323 outcomes, 318, 319, 323 327 Spine anatomy, annulus fibrosus, 42, 43, 45 capsular ligamentum flavum complex, 45 dural sac, 39 epidural adipose tissue, 38 intracanalicular ligaments, 39 nerve roots and ganglia, 31 33, 35 nucleus pulposus, 41 paraspinal muscles, 29 posterior longitudinal ligamentum, 45 thoracolumbar fascia, 29 triangular working zone, 29, 31 vasculature, 35 38, 151 153, 157, 158 Spondylodiscitis, see Pyogenic spondylodiscitis SSEP, see Somatosensory evoked potential Steroid therapy, coccydynia, 275 epidural steroid injection, 272 274 perineural therapy, 122 sacroiliac joint steroid injection, 274, 275 skin hypersensitivity management, 149 transforaminal therapy, 122 Substance P, pain generation role, 121 Sympathectomy, laser, 264 267 T Thermal intradiscal therapy, principles, 124
Index 383 Thoracolumbar fascia, anatomy, 29 Transpedicular biopsy, anatomy, 172, 173 complications, 174, 175 computed tomography guidance, 175 historical perspective, 167, 168 rationale, 167, 168, 174 technique, 168, 170, 171 Transpedicular discectomy, see Percutaneous transpedicular discectomy Triangular working zone, anatomy, 29, 31 arthroscopic and endoscopic examination, 83, 86, 87 identification for anchoring of instruments, 15, 16 Triphens, posterolateral access, 49, 50 V Vasoactive intestinal polypeptide (VIP), pain generation role, 121 VCF, see Vertebral compression fracture Venous hypertension, animal experiment studies of venous radiculomedullary circulation, 159, 160 neurogenic pain role, 153 155 slow vs rapid compression of nerve roots, 160 Vertebral compression fracture (VCF), epidemiology, 239 kyphoplasty, complications, 246 outcomes, 244 246 overview, 240, 242 technique, 242 244 vertebroplasty comparison, 247 nonoperative management, 239 percutaneous vertebroplasty, complications, 241, 242 kyphoplasty comparison, 247 outcomes, 241 overview, 240, 241 polymethyl methacrylate injection, 240, 241 prospects for management, 247, 248 Vertebroplasty, see Percutaneous vertebroplasty VIP, see Vasoactive intestinal polypeptide X X-Stop interspinous process distraction device, advantages, 327, 330 anesthesia, 320, 323 operative technique, 320, 322, 323 outcomes in spinal stenosis, 318, 319, 323 327 Y YESS system, see Yeung Endoscopic Spine Surgery system Yeung Endoscopic Spine Surgery (YESS) system, selective endoscopic discectomy, 205, 207, 222