Neurospine Endoscopic Spinal Surgery, 2nd Issue

Michael Mayer

doi:10.14245/ns.2040418.209

The technical advancement of endoscopic spine surgery is inexorable and fascinating. Indications are expanding, the number of surgeons who are beyond their individual learning curves is increasing. Technical skills especially of the younger generation of spine surgeons are getting better and better. The instruments available for different surgical tecniques are getting more and more sophisticated.

This is the second issue of a NASS-Neurospine Visualized Endoscopic Spine Surgery publication on endoscopic spine surgery which contains 19 papers/video technical tutorials, 10 of which I had the pleasure to read/view.

There is an introductory paper which describes the clinical and economic advantages of endoscopic spine surgery with a focus on the benefits for patients life quality.

Two articles focus a on new indications of endoscopic surgery in the cervical spine. I believe, that the very interesting transcervical retropharyngeal approach to the odontologisch process has the potential to replace transoral surgery.

A case report which describes multisegmental full-endoscopic posterior drainage of cervical epidural abscess opened a new perspective to deal with this severe disease.

For the treatment of central spinal stenosis, the inside-out full-endoscopic cross-over approach is presented including the 1 year clinical follow-up of 127 patients. Even though there is a considerable learning curve, I believe that this technique can produce clinical results comparable to the standard microsurgical cross-over decompression in degenerative lumbar spinal stenosis.

Four papers/videos in this issue focus on biportal endoscopic approaches for lumbar decompression, discectomy, minimally invasive transformational lumbar inter body fusion and even revision surgery e.g., in case of postoperative epidural hematoma. This technical variation of posterior full-endoscopic approaches allows for wider fields of endoscopic vision and a perfect way of triangular surgery such as in knee-arthroscopic techniques. Especially for fusion surgery this might be a promising technique. The clinical application in the cervical spine is described for bilateral foraminotomy in cases with bilateral radiculopathies.

Last but not least another microsurgical approach has been ‘transformed’ to a full-endoscopic technique: the translaminar approach for cranial migrated disc herniations. This is a technically demanding approach but I believe that when it is performed with full-endoscopic technique it can be even less invasive as compared to microsurgery.

In summary, the papers I could read are excellent examples of the ongoing technical evolution (revolution?) of endoscopic spine surgery and I congratulate the authors for their pioneering work.