Index

Textbook of Surgical Management of Lumbar Disc Herniation PS Ramani, Chun-Kun Park, Abdul Hafid Bajamal, Christopher M Loftus, Enrique Osorio-Fonseca, Junichi Mizuno, Sushil Patkar

SECTION 1: HISTORICAL EVOLUTION OF LUMBAR DISC HERNIATION
1:Back Pain, Sciatica and Herniated Lumbar Intervertebral Disc Historical Anecdote
2:History of Lumbar Disc Disease and Herniation
- Prior to 20th Century
- 20th Century—First Half
- 20th Century—Second Half
- Artificial Disc Technology
- Conclusion
3:Evolution and Progress of Concept of Minimally Invasive Surgical Management of Herniated Lumbar Intervertebral Disc
- Evolution
- Progress
- Minimally Invasive Concepts
- Progress in Minimally Invasive Surgical Techniques
SECTION 2: BASIC KNOWLEDGE IN LUMBAR DISC HERNIATION
4:Applied Anatomy and Normal Functions of Lumbar Spine
- Applied Anatomy
- Normal Functions of the Lumbar Spine
5:Microanatomy of Degenerative Disc Disease
- Introduction
- Uppsala Cryoplanning Technique
6:Natural History of Degenerative Changes in Lumbar Spine
- Introduction
- Relevant Anatomy
- Etiology and Pathogenesis of Disc Degeneration
- Clinical Manifestations
- Conclusion
7:Clinical Biomechanics Related to Lumbar Disc Degeneration and Herniation
- Introduction
- Basic Biomechanical Principles
  - Measurements of Force and Moment
  - Kinematics and Stability
- Biomechanically Related Anatomy and Physiology
- Spondylosis and Degeneration
  - Loading History
- The Aging Spine
  - Spinal Alignment
  - How is Low Back Pain Related to Disc Degeneration?
- Biomechanics of Intervention
- Biomechanics of Nonfusion Implants and Dynamic Stabilization
- Biomechanics of Traction Devices
- Conclusion
- Acknowledgment
8:Factors Responsible for Symptomatology of Lumbar Disc Herniation
- The Origin of Back Pain and Sciatica
- Factors Causing Back Pain and Sciatica
9:Clinical Presentation of Lumbar Disc Herniation
- Introduction
- Neurogenic Claudication
- Blood Supply
- Back Pain
- Sensory Dysfunction
- Sciatic Pain
- Sciatica
- Physical Signs
SECTION 3: INVESTIGATIONS
10:Role of CT in Diagnosis of Lumbar Disc Herniation
- Introduction
- Indications for CT Myelogram
- Technique of CT Myelogram
- Anatomy and Physiology
- Pathology
- Possible Complications
- Conclusion
11:MRI in Diagnosis of Herniated Lumbar Intervertebral Discs
- Introduction
- Relevant Anatomy
- MRI Anatomy of the Disc
- The Pathological Disc
- Ancillary Features of an Overall Degenerative Process: The Mimics of a Discogenic Pain
- The Postoperative Spine
  - Soft Tissue Changes
- Failed Back Surgery Syndrome
- Conclusion
12:Image Diagnosis of Lumbar Disc Herniation
- Introduction
- Plain Radiography
- Computed Tomography
- Magnetic Resonance Imaging
- Discography and CT Discography
- Myelogram
- Myelo-CT
- Summary
SECTION 4: SURGICAL TECHNIQUES
13:Lumbar Laminectomy
- Introduction
- Factors Contributing to Lumbar Canal Stenosis
  - Advantages
  - Disadvantages
- Surgical Technique
- Laminoplasty Instead of Laminectomy
- The Closure
- Complications
- Conclusion
14:Microlumbar Decompression for Lumbar Disc Disease
- Introduction
- Indication for Surgery
  - Clinical Evaluation
  - Imaging Evaluation
- Operative Techniques
- Lateral Recess Stenosis
- Foramen Decompression
- Multiple Disc Prolapse
- Wound Closing
- Special Situation
- Complication
- Results
- Conclusion
15:Lumbar Microdiscectomy with Preserving of Ligamentum Flavum and Fat Tissue
- Prognosis in Patients Undergoing Lumbar Disc Surgery
- Surgical Procedures for Lumbar Disc Herniation Up to Now
- Terminology
- Surgical Microscope
  - Advantages
  - Disadvantages
- Indications for Surgical Treatment of Lumbar Disc Herniation
- Patient Selection Criteria [American Academy of Neurological Surgeons (AANS), American Academy of Orthopedic Surgeons (AAOS)]
- Preoperative Planning
- Anesthesia
- Preparation of the Patient and Position
- Skin: Interlaminar Approach
- Preserving of Ligamentum Flavum
- Approach to the Spinal Canal with One-sided Flap Technique while Maintaining the Ligamentum Flavum
- Advantages of Preserving of Ligamentum Flavum
- Identification of Nerve Root
- Identification of Disc Herniation
- Removal of Disc Herniation
- Discectomy
- Closing
- Postoperative Care
- Complications
- Preoperative Poor Prognostic Factors
- Conclusion
16:Annular Repair in Lumbar Discectomy
- Introduction
- Annulus Fibrosus: Structural and Molecular Composition
  - Facet Joints
- Physiology of the Intervertebral Disc
- Annular Healing
- Annular Healing Influenced by Surgical Technique
- Need for Repair
- Techniques of Repair
- Newer Research in Regenerative Techniques
  - Cell and Gene Therapy
  - Scaffolds
- Challenges in Research
- Conclusion
17:Discoplasty after Excision of Herniated Disc
- Introduction
- Author's Technique
- Results
- Conclusion
18:Far Lateral Disc Prolapse
- Introduction
- Anatomy
- Etiology/Pathogenesis
- Clinical Presentation
  - Imaging
  - Treatment
- Summary
19:Extraforaminal Approach to Lumbar Disc Herniations
- Introduction
- History
- Anatomy
- Clinical Findings
  - Indications of Extraforaminal Approach
- Surgical Technique
  - Skin Incision
  - Soft Tissue Dissection
- Combined Extraforaminal: Medial Approach
- ELIF Applications with Far Lateral Extraforaminal Approach
- Complications
- Conclusion
20:Surgical Management of Extraforaminal (Far Lateral) Disc Herniations
- Introduction
- Clinical Findings
- Treatment
- Conclusion
21:Minimally Invasive Treatment for Back Pain: A Review
- Introduction
- History and Evolution
- Pathophysiology and Clinical Symptoms
  - Discogenic Back pain
  - Five Cardinal Symptoms of Degenerative Disc Disease
- Facetal Pain
  - Classification of Facet Degeneration
- Sacroiliac Joint Pain
- Treatment
22:Percutaneous Transforaminal Endoscopic Lumbar Discectomy: Transforaminal Endoscopic Spinal System Method
- Introduction
- Various Types of Approaches Used for Lumbar Discectomy (Past and Present)
- Historical Developments
- Laser Lumbar Discectomy
- Applied Anatomy of the Lumbar Spine (Fig. 22.1)
  - Surface Anatomy
  - Radiological Anatomy
- Anatomy of the Intervertebral Foramen (Fig. 22.2)
- Boundaries and the Contents of the IVF
- Boundaries of the Intervertebral Foramen
  - Roof
  - Floor
  - Anterior Wall
  - Posterior Wall
  - Medial Wall
  - Lateral Wall
- Structures in the Intervertebral Foramen
  - Nerves
  - Artery
  - Veins
- Anatomy of the Triangular Safe Zone of ‘Kambin’ (Fig. 22.4)
- Applied Anatomy and Safe Needle Passage
- Endoscopic Anatomy (Fig. 22.7)
- Percutaneous Transforaminal Endoscopic Lumbar Discectomy
  - Indications
  - Advantages of the Operation
  - Disadvantages
  - Contraindications
  - Operation Theater and Equipment
- Endoscopes and Surgical Instruments
  - Anesthesia
  - Conscious Sedation
- Operative Technique
  - Step 1
    - Theater Set-up and Position of the Patient (Figs 22.15A to C)
  - Step 2
    - Needle Insertion and Discography (Figs 22.16A to H)
  - Step 3
    - Dilators, Reamers (Figs 22.17A to G) and Endoscope Sheath (Figs 22.18A and B)
  - Step 4
    - Endoscopic Discectomy (Figs 22.19A to D)
  - Postoperative Period
- Transforaminal Operative Technique (Further Considerations)
  - Low-grade Migration
  - High-grade Migration
- Anatomical Considerations and the Need for Foraminoplasty
  - Foraminoplasty
  - Conventional Foraminoplasty (Fig. 22.21)
  - Extended Foraminoplasty
- Downward or Upward Migrated Disc Herniations
  - Downward Migrated Disc Herniations
  - Upward Migrated Disc Herniations
  - Far Lateral Disc Prolapse (Special Scenario) (Figs 22.22A and B)
  - Complications
- Future Developments
- Laser in Endoscopic Spinal Surgery
- Review of Literature
- Summary
- Clinical Practice Guidelines
- Conclusion
23:Percutaneous Endoscopic Lumbar Discectomy
- Introduction
- Procedure
- Complications of Surgery
- Conclusion
24:Percutaneous Transforaminal Endoscopic Discectomy
- Introduction
- New Concepts
- Indications
- Contraindications
- Operative Technique
- Marking Entry Point (Figs 24.2A and B)
- Postoperative Care
- Possible Complications
- Conclusion
25:Percutaneous Endoscopic Lumbar Discectomy (History, Evolution, Surgical Strategy, Outcome and Complications)
- History and Evolution
- Rationale for MISS
- The Inclusion and Exclusion Criteria
- Surgical Techniques and Strategies
- Cutting Edge of Percutaneous Endoscopic Lumbar Discectomy (PELD)
- Postoperative Care
- Limitations of Percutaneous Endoscopic Lumbar Discectomy (Figs 25.13 to 25.18)
- Complications
  - Procedure-related Complications
26:Minimally Invasive Surgical Management of Lumbar Disc Herniation by Anterior Epidural Endoscopy: Epiduroscopy
- Introduction
- Material and Methods
- Procedure Technique
- Results
- Discussion
- Conclusion
27:Lumbar Microendoscopic Discectomy
- Introduction
- Indications
- Contraindications
- Surgical Procedures
- Postoperative Care
- Complications and Avoidance
- Conclusion
28:Minimally Invasive Lumbar Microdiscectomy
- Introduction
- History
- Surgical Technique
- Complications
- Review of Results
  - Outcomes
  - Cost Analysis
- Conclusion
29:Tubular Microsurgical Discectomy for the Treatment of Lumbar Disc Herniation
- Introduction
- Patients and Methods
- Results
- Discussion
- Conclusion
30:Endoscopic Spine Surgery as Treatment for Lumbar Disc Herniation and Foraminal Stenosis
- Historical Perspective of Low Back Endoscopy
- Low Back Endoscopic Equipment
- Disc Herniation and Low Back Foraminal Stenosis Treatment via Endoscope
  - Lumbar Percutaneous Endoscopic Discectomy
31:Minimally Invasive Technique for Lumbar Disc Herniation
- Introduction
32:Laser Assisted Percutaneous and Endoscopic Lumbar Discectomy
- Introduction
- Laser System
- Laser Techniques
- Conclusion
33:Thermodiscoplasty and Percutaneous 360 degree Rhizolysis as a Treatment for Herniated Disc or Facet Lumbar Pain
- Introduction
- Importance and Origin of Disc and Facet Pain
  - Thermal Intradiscal (Thermodiscoplasty) and Facet Therapy for Low Back Pain
  - Biological Effects and Physiopathology of Thermodiscoplasty
- Thermodiscoplasty and 360 degree Rhizolysis
- Conclusion
34:Lumbar Discs Herniation Treated by Ozone Therapy
- Introduction
- Background
- Patients and Methods
- Technique
- Guidelines and Assessments
- Results
- Complications
- Discussion
- Conclusion
35:Use of Robots in the Surgical Management of Lumbar Disc Herniation: Dream or Reality
- Introduction
- Clinical Use of Robotic Technology
- Some Results
- Increased Popularity
- Mandatory Requirements
- Current Application of Robotic Technology in Spinal Surgery
- Discussion
- Future Developments
- Conclusion
SECTION 5: SURGICAL TECHNIQUES INFREQUENTLY USED IN LUMBAR DISC HERNIATION
36:In-Space Interspinous Distraction Device for Stabilization of Lumbar Spine in Motion Segment Instability in Lumbar Disc Herniation
- Introduction
- Pathophysiology
- Principles of Management
- Indications
- Contraindications
- The Implant (In-Space Device)
  - Principle of Action
- Essential Preoperative Requirements
- Surgical Technique
- Results
- Complications
- Conclusion
37:New Surgical Method for Lumbar Disc Herniation Associated with Lumbar Canal Stenosis
- Introduction
- Surgical Technique
- Case Presentation
- Discussion
38:Lumbar Instrumentation Surgery with Pedicle Screws in Lumbar Disc Herniation
- Introduction
- Evaluation of the Patient Lumbar Spine
- Surgical Procedure
- Exposure and Decompression
- Cage Insertion
- Pedicle Screw Insert
- Complications
- Conclusion
39:Total Disc Replacement of Lumbar Spine
- Introduction
- Biomechanics
- Types of Artificial Disc and Insertion Techniques
- Indications
- Clinical Results
- Complications
- Prospects
- Epilogue
40:Techniques, Indication and Outcome of Transforaminal Interbody Fusion in Surgical Management of Lumbar Disc Herniation
- Introduction
- Lumbar Interbody Fusion Techniques
- Surgical Technique of Open Transforaminal Lumbar Interbody Fusion
- Surgical Technique of Minimally Invasive Transforaminal Lumbar Interbody Fusion
- Decision Making in Selecting Different Approaches of Interbody Fusion
- Indications for Transforaminal Lumbar Interbody Fusion
- Clinical Outcome and Fusion Rate of Minimally Invasive Transforaminal Lumbar Interbody Fusion
- Conclusion
41:Association of Lateral Recess Stenosis with Lumbar Disc Herniation
- Introduction
- Results
- Conclusion
42:Minimally Invasive Space Shuttle Laminotomy for Degenerative Lumbar Spinal Canal Stenosis
- Introduction
- Anatomy of Ligamentum Flavum
- Surgical Technique of Minimally Invasive Space Shuttle Laminotomy
- Conclusion
SECTION 6: COMPLICATIONS IN SURGERY FOR LUMBAR DISC HERNIATION
43:Diagnosis and Management of Discitis Following Lumbar Disc Surgery
- Introduction
- Epidemiology
- Pathophysiology
- Diagnosis
- Clinical Findings
- Paraclinical Evaluations
  - Laboratory Studies
  - Imaging Studies
- Biopsy and Culture
- Management
- Prophylaxis and Prevention
- Prognosis
44:Failed Back Surgery Syndrome in Lumbar Disc Herniation
- Introduction
- Classification of Failed Back Surgery Syndrome Based on Time of Occurrence
  - Proper Selection
  - Late Presentation
- Surgery
  - First Surgical Intervention is Crucial
  - Surgeon's Outlook
- Common Clinical Problems
- Presenting Clinical Features
- Criteria
- Unhappy Patient
45:Recurrent Disc Herniation
- Introduction
- Etiology
- Epidemiology
- Diagnosis
- Treatment
  - Discectomy Only
  - Fusion
- Complications
- Outcome
- Avoiding Recurrence
- Conclusion
46:Complications in Surgical Management of Lumbar Disc Herniation: Past and Present
- Introduction
- Scope of the Chapter
- Evolution of Lumbar Discectomy
- Success and Complication Rates of Discectomy
- Vision Loss
- Wrong-Site Surgery
- Dural Tear and Cerebrospinal Fluid Leakage
- Vascular Injury
- Bowel Injury
- Ureter Injury
- Neurologic Injury
- Epidural Hematoma
  - Gelfoamoma
- Ogilvie's Syndrome
- Infection
- Recurrent Disc Herniation
- Textiloma/Granuloma
- Failed Back Surgery Syndrome
- Conclusion
SECTION 7: FOLLOW-UP
47:Short-term Results of Microlumbar Discectomy for Herniated Lumbar Intervertebral Disc
- Introduction
- Material and Methods
- Operative Technique
- Results
- Discussion
  - Recurrence
- Conclusion
48:Long-term Follow-up of Surgical Patients of Microlumbar Discectomy
- Introduction
- Methodology
- Material
- Patients Seen with Recurrent Disc Prolapse
- Analysis of Data (Tables 48.6 to 48.16)
- Evaluation of Data
- Discussion
- Conclusion
49:Long-term Results of Surgery for Lumbar Disc Herniation
- Introduction
- Patient Selection
- Results
- Discussion
- Conclusion

INDEX

TOC
Index

Chapter Notes