minimally invasive spine surgery and posterolateral endoscopic discectomy gabriele jasper, m.d....

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