徐少克

 童綜合醫院 骨科部

  Endoscopic spinal surgery, at a crossroads similar to that of arthroscopic  knee surgery in the 1970s, is poised to serve the same role. Percutaneous  endoscopic discectomy techniques in spine surgery have evolved rapidly in the  past several years. It was first introduced in the United States by Kambin et  al in 1973 and the working triangle of nerve root was described and  illustrated by Kambin in 1991.

  Improvements in scope design, access cannulas, instrumentation, and  adjunctive therapy now allow for a wider spectrum of endoscopic procedures  that include routine spinal probing, tissue resection, tissue modulation, and  ablation. These advancements have enhanced the surgeon’s ability to diagnose  and treat discogenic pain and take on the full spectrum of disc herniations ,  including extruded and sequestered fragments.

  The posterolateral endscopic discectomy technique was recognized as  potentially even less invasive compared with the more familiar  microscope-assisted transcanal approach. The satisfactory rate increase up to  90% since 2002 and can get the same result as standard discectomy procedure.  The advantages of PELD are less trauma, rapid recover, less risk, less  complications. In a contained herniated disc,

  intradiscal surgery minimizes the incidence of recurrent herniation by  protection of partially intact posterior annular fibers and posterior  longitudinal ligament. Percutanenous endoscopic surgery with Interlaminal and  extra-lateral approach can deal with L5S1 and sequestered discs and foraminal  trap these are difficult deal with standard posterolateral approach. The  indications of PELD now is more extend including contained, noncontained,  recurrent, and far lateral discs, infective spondylodiscitis, lateral  stenosis, discogenic pain and disc fusion.

  In the future percutaneous endoscopic surgery will only be a small part of  the surgical process that will incorporate techniques of tissue augmentation  such as annular reinforcement and nuclear replacement. Adjunctive therapy  such as chymopapain, injectable biomaterials that enhance tissue healing or  endoscopic means of segmental stabilization or fusion will be an integral  part of this technique.