Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note.

Suxi Gu,Songhua Xiao,Xifeng Zhang,Kedong Hou,Jianwei Du,Wei Jian

doi:10.1155/2018/4749560

Abstract

Purpose Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.

Highlights

Open lumbar discectomy is the gold standard surgical technique for lumbar disc herniation, iatrogenic damage on the facet joints and other paraspinal structures along with reduced disc height, segmental instability, and retrolisthesis may become a problem [1, 2]
We propose a Kiss-Hug maneuver to efficiently and safely decompress foraminal stenosis, utilizing one of the fundamental tools in the percutaneous endoscopic lumbar discectomy (PELD) procedure: the working cannula
This technique maximizes the effectiveness of endoscopic decompression while ensuring patient and surgeon safety. In this endoscopic foraminoplasty maneuver, the bevel tip of the working cannula is used as a bone reamer to undercut the superior articular process (SAP) without the need for any other specific instrumentation

Summary

Introduction

Open lumbar discectomy is the gold standard surgical technique for lumbar disc herniation, iatrogenic damage on the facet joints and other paraspinal structures along with reduced disc height, segmental instability, and retrolisthesis may become a problem [1, 2]. C-arm-guided foraminoplasty may cause unintended multifluoroscopic exposure, inadequate bone removal, bleeding, significant bony structure removal causing lumbar instability, and even sensitive neural damage [16,17,18,19,20] To address these concerns, specialized tools for endoscopic foraminoplasty have been developed, such as endoscopic drills, high-speed diamond and articulated burrs, punches, forceps, osteotomes, and the straight- and side-firing Holmium-YAG laser [15, 21]. We propose a Kiss-Hug maneuver to efficiently and safely decompress foraminal stenosis, utilizing one of the fundamental tools in the PELD procedure: the working cannula This technique maximizes the effectiveness of endoscopic decompression while ensuring patient and surgeon safety. In this endoscopic foraminoplasty maneuver, the bevel tip of the working cannula is used as a bone reamer to undercut the SAP without the need for any other specific instrumentation

Technical Note

Discussion

Conclusions

Conflicts of Interest