Minimally Invasive Spine Surgery and Posterolateral Endoscopic Discectomy
Gabriele Jasper, M.D.
AnesthesiologistInterventional Pain Physician
Center for Pain ControlBrick, NJ Milltown, NJ
Common Indications-Posterolateral Endoscopic Discectomy
1. A patient with back pain and/or radicular pain who has failed conservative treatment
2. Any herniation accessible endoscopically (directly proportional to experience)
3. Patient who refuses open surgery
4. Discogenic Pain
5. Discitis
Contraindications - Contraindications - Endoscopic SpineEndoscopic Spine
• Any pathology not accessible from the posterolateral endoscopic approach
– Severe central canal stenosis • Inadequate support staff or equipment to
successfully perform procedure• Uncooperative patient• Instability
Surgical ApproachKambin’s Triangle
Exiting Nerve
Endplate
Transversing Nerve Root
MRI with HNP and Facet MRI with HNP and Facet HypertrophyHypertrophy
Neuroforaminal StenosisNeuroforaminal Stenosis
T2 sagittal MRI showing HNP, left L4-L5 with compression of L5 nerve root
T2 axial MRI showing HNP left L4-L5 with compression of L5 nerve root
The Inside Out The Inside Out TechniqueTechnique
The Outside Inside The Outside Inside TechniqueTechnique
Disc ApproachesDisc Approaches
The Endoscopic The Endoscopic ApproachApproach
• Surgical approach
• The interventional pain approach
• The modified surgical/interventional pain approach
Surgical ApproachSurgical Approach
Interventional Pain Interventional Pain ApproachApproach
Endoscopic HydroDiscectomy Instrumentation
SpineJet®
EndoResector
Endoscopic Discectomy with Foraminotomy and Annuloplasty
Defect Created By the Defect Created By the EndoResectorEndoResector
Pre-op OrdersPre-op Orders
1. Standard Pre-op Orders
2. Ancef 1gm I.V. or Gentamycin
3. All solutions that enter the disc need to have 10% antibiotic
Post-operativePost-operative OrdersOrders1.Follow-up one week
2. Back Brace during activity for six
weeks
3.No work 1-2 weeks (depends on type of work)
4.No heavy lifting until re-evalution
5.Pain Medication
Questions ??
Thank You Thank You