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Percutaneous posterolateral foraminoscopy

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Percutaneous posterolateral foraminoscopy operation description

Together with leading spinal surgeons was designed tools for the treatment of herniated disc, which has a number of advantages.

The foraminoscope can be localized under video control through a working channel (3.9 mm) with two separate channels for suctioning and rinsing out-of-disk fragments and removing them with tools, such as gripping forceps, spoon-shaped forceps, scissors and hooks. Small fragments can be vaporized with a laser.

Access is performed in a known way using a puncture needle, a string and expanders. Through the surgical sleeve, the foraminoscope is inserted into the fibrous ring (anulus fibrosus).

Extraforaminal and interlaminar (contralateral) approach for foraminotomy. The interlaminar foraminotomy can decompress the lateral recess, foraminal zone.
Extraforaminal foraminotomy allow decompressing the extraforaminal zone.
Extraforaminal foraminotomy allow decompressing the extraforaminal zone.

The advantages of percutaneous posterolateral foraminoscopy

Transforominal access to the epidural space has the following advantages:

  • yellow ligament (ligamentum flavum) is not disclosed, thereby reducing segmental instability
  • sequestered hernia is captured directly, so that the posterior fibrous ring (anulus fibrosus) and the longitudinal ligament remain intact
  • nucleus pulposus is not completely removed, leading to a reduction in segment instability
  • operation can be performed on an outpatient basis under local anesthesia
  • in many cases immediate pain relief for patient

Comparison between foraminal and interlaminar (contralateral) foraminotomy

 
Percutaneous Endoscopic Transforaminal Lumbar Foraminotomy
Percutaneous Endoscopic Interlaminar Lumbar Foraminotomy
Learning curve Relatively short Long
Decompression of lateral recess and subarticular region Not possible without risk of facet violation Good
Decompression of extraforaminal region Good Not possible
Better suited for "Soft" disc herniation "Hard" calcified disc herniation, spinal canal degenerative stenosis, facet hypertrophy, facetal cyst
Anesthesia Local Epidural

 

Convenience of operation

The eyepiece and light guide are separated from the instrument and located on the operating table along with the camera. This allows the surgeon to focus on the operation and use of the necessary tools.

 

Single-port access

Through one access, observation, treatment, rinsing and aspiration are possible. This reduces the risk of infection and shorten the duration of the operation, as well as reduce the burden on the patient.

 

System included

Tools for access:

  • optical component
  • convenient tool for removing fragments
  • stand with camera, VCR and washing device

All components of the system are sterilizable and reusable, optimally matched to each other and provide functional and safe use during the surgical intervention.