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REVIEW ARTICLE
Endoscopic spine discectomy: indications and outcomes
Yong Ahn
1
Received: 3 November 2018 /Accepted: 26 December 2018 /Published online: 5 January 2019
#
SICOT aisbl 2019
Abstract
Purpose Percutaneous endoscopic discectomy is an effective minimally invasive spine surgery (MISS) for soft disc herniations.
The objective of this review was to describe the current indications, surgical techniques, and clinical outcomes of endoscopic
spine surgery.
Methods A narrative review was performed with a focus on surgical indication of percutaneous endoscopic discectomy and the
clinical outcomes in lumbar and cervical spine. Percutaneous endoscopic or full-endoscopic discectomy using a working channel
endoscope was described.
Results The basic principles, surgical techniques, and clinical outcomes in lumbar and cervical disc herniations were demon-
strated. For the lumbar disc herniation (LDH), transforaminal and interlaminar approaches were reviewed, whereas for the
cervical disc herniation (CDH), anterior and posterior approaches were reviewed.
Conclusions Endoscopic spine surgery for soft disc herniation can be effective with benefits of minimal tissue trauma in properly
selected cases. Given the recent technical advancements, the surgical indications for endoscopic spine surgery are still expanding
and the clinical results have become more practical and reliable.
Keywords Discectomy
.
Endoscopic
.
Indication
.
Interlaminar
.
Transforaminal
Introduction
Radiculopathy which stemmed from lumbar, cervical, or tho-
racic disc herniations is the most common reason why patients
require extensive and special treatment. The conventional sur-
gical technique for disc herniations is open discectomy with or
without fusion surgery. However, considerable sequelae relat-
ed to the surgical trauma and long recovery time have been the
major problems of spinal surgery. For that reason, the need for
minimally invasive spine surgery (MISS) is growing as the
aging population in many countries is dramatically increasing
and the quality of life is given more importance nowadays [1,
2].
Since Hijikata [3] and Kambin [4] independently intro-
duced the posterolateral percutaneous lumbar nucleotomy
technique, a group of endoscopic spine surgery has been a
significant minimally invasive surgical alternative for spinal
disc herniations.
The advantages of endoscopic spine surgery are as follows:
a stab skin incision, do not require muscular retraction, avoid-
ance of excessive bone removal, minimal neural manipula-
tion, feasibility under local anaesthesia, minimal blood loss,
shorter operative time, and early return to normal activities of
daily living [5–7].
Given the technical development of endoscopic spine sur-
gery, including optics design, surgical instruments, and spe-
cific surgical approach, its clinical application became practi-
cal and standardized [8, 9].
This review article presents a discussion of the proper in-
dications of endoscopic spine discectomies and to demon-
strate their outcomes. Furthermore, we describe the technical
considerations for endoscopic spine surgery to achieve a clin-
ical success.
Basic concepts and history
The basic concept of endoscopic spine discectomy is to pro-
vide a direct access to the disc pathology with minimal tissue
trauma and to remove the herniated disc under endoscopic
* Yong Ahn
ns-ay@hanmail.net
1
Department of Neurosurgery, Gil Medical Center, Gachon University
College of Medicine, 21, Namdong-daero 774 beon-gil,
Namdong-gu, Incheon 21565, Republic of Korea
International Orthopaedics (2019) 43:909–916
https://doi.org/10.1007/s00264-018-04283-w
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