455 - Nano Endoscopic Approach for Central Lumbar Disc Herniations...

#455 Nano Endoscopic Approach for Central Lumbar Disc Herniations

Endoscopic Surgery

Poster Presented by: D. Ditsworth


D. Ditsworth (1)
G. Geer (2)
L. Lombardi (3)

(1) Back Institute, Los Angeles, CA, United States
(2) Back Institute, Research, Los Angeles, CA, United States
(3) Back Institute, Surgery, Los Angeles, CA, United States


Central disc herniations in the lumbar spine are difficult to access. With the typical so called “minimally invasive” techniques, substantial bone removal needs to occur which increases the likelihood of instability and failed back surgery syndrome in the long run. We use a double access, “nano” approach with a small endoscope which produces no trauma to the normal spine. The first access targets the interior of the disc and provides decompression, the second access is more lateral and almost 90 degrees perpendicular to the A-P axis of the vertebral unit and targets specifically the herniated portion of the disc, whether it is contained or not. The pathologic disc material is removed from the spinal canal with the use of micro-tools. Because the second approach is in close proximity to the abdominal cavity, for safe access it is essential to request a wide view CT through the affected levels.
A retrospective analysis from 2002 was performed by one of the authors. A total of 107 patient records were gathered; 66% males and 34% females, ages ranging 12 to 83 years old. There were 65 L4/5, 34 L5/S1 and 8 L3/4 herniations; 66% were contained and 34% extruded. The average f/u was 9 weeks. The results were reported utilizing the MacNab criteria. No access limitation was shown on wide view CT scans.
Results were as follows: Excellent: 52.33% (n=56), Good: 38.31% (n=41), Fair: 8.41% (n=9) and Poor: 0.95% (n=1) with an overall success rate of 90.64%. No complications. The “Nano”, approach is highly successful, very safe and avoids the deleterious long term effects of bone removal and tissue dissection that may lead to failed back surgery syndrome. These procedures are fundamentally different in that there is no access trauma to the spine.