General Session: Endoscopic Surgery

Presented by: K. Lawson

Author(s):

K. Lawson(1,2)

(1) Loma Linda University Medical Center, Orthopedic Surgery, Loma Linda, CA, United States
(2) Michigan Clinic Neurosurgery, Spine Surgery Clinic, Saginaw, MI, United States

Abstract

Purpose to Review Clinical Results of an Endoscopic Approach to initial Debridement of Thoracolumbar Discitis and its complications.

Method: A retrospective review was done of patient´s whose thoracic and lumbar discitis and osteomyelitis was approached for initial biopsy and irrigation by a transforaminal endoscopic technique. 6 patients were identified from approximately a two year period 2015-2017.A concurrent group of patients treated also by endoscopic approach with disc herniation or foraminal stenosis was reviewed as a comparison who had a transforaminal intervention. Chart review via EMR and PACS review was done of all relevant cases. The Author preformed all the reviewed procedures preformed at a University referral teaching hospital. All office notes were reviewed for late complications of the exposure.

Results: The endoscopic groups both had no hard neurologic deterioration or major nerve injuries and no vascular or visceral complications. Exchange between tubular dialator system retraction to initally approach Kambins triangle and a full endoscopic surgical system was found to be easily accomplished both up and down in size. Good sampling of disc material and adjacent annular /bone tissues was able to be accomplished in all cases and culture yields were good. No case proved inaccessible in this series from mid thoracic to L5S1. The approach leaves the lamina and central epidural space unscarred should additonal procedures be necessary either from a conventional anterior or posterior approach. One patient in the HNP group had an intraoperative severe allergic reaction to intradiscal contrast and required abortion of the initial decompression procedure. This patient tolerated the intervention well without contrast preformed on a subsequent intervention.

Conclusions: Transforaminal approach to the midthoracic through Lumbosacral spine for not only degenerative but infectious and inflammatory conditions is feasible and in this small series showed no major adverse neurologic changes.