Back and neck pain is one of the most common reasons for visiting doctors. Apart from poor posture, prolonged sitting, lifting, repeated bending, obesity and injury from accidents, the degeneration diseases of the disc are some important contributing factors to the pain. Degenerative symptoms in the spine are on the rise, which cause great medical and economic problems.
In some cases, the discomfort in the spine area can be cured by some simple treatments such as bed rest, exercise, physiotherapy and pain medication. Where severe pain persists and all conservative treatment options have been exhausted, surgery may be required. Though traditional surgery can achieve good results, it often involves general anesthesia, the dissection of muscle, removal of bone, manipulation of nerve roots. In an effort to overcome these disadvantages of traditional surgical techniques, medical teams began exploring a more minimally invasive technique. They have come up with chemonucleolysis by intradiscal-injection of chymopapain or collagenase and percutaneous intradiscal ozone-injection, PIOI, then the percutaneous laser disc decompression, PLDD. All these techniques are only indicated in some bulging disc and cannot solve the disc problems thoroughly.
Degenerated disc and spinal stenosis are common problems requiring decompressive surgery. Open spinal discectomy is associated with significant morbidity, long-term convalescence, prolonged general anesthesia and wide dissection of tissues that can cause bleeding, scarring and eventual destabilization of spinal segments. The evolving less traumatic minimally invasive endoscopic decompression procedure is free from these potential complications. Therefore the pursuit of minimally invasive spine surgery (MISS) began. Percutaneous endoscope decompression has come into being. The use of endoscope in the spine surgery has greatly promoted the development of minimally invasive spine surgery. It provides clear visualization and magnification of deep structures. Minimally invasive techniques can reduce tissue damage and its consequences. We proposed three different access routes: tansforaminal, extraforaminal and interlaminar approaches. For different techniques, we have corresponding endoscopes which can respectively be applied in the cervical, thoracic and lumbar regions. These approaches broaden the range of indications. They are visually controlled procedure that is as effective as conventional surgery while benefiting from all the advantages of truly minimally invasive surgery.
New rod lenses with a 4.3mm intraendoscopic working channel and corresponding new instruments, as well as shavers and burrs were therefore developed so that full-endoscopic operations could be performed under continuous and precise visual control. Full-endoscopic surgery has now won a firm place in the surgery of spine conditions. It suggests a revolutionary change in the spine surgery. Nevertheless, conventional and maximally invasive operations will continue to play an indispensable role in spinal surgery. Surgeons will need to be able to perform these techniques in order to overcome problems and complications of full-endoscopic operations such as can occur with any invasive procedures.
The development of full-endoscopic spine techniques should not be seen as the end of existing operative techniques; rather, it should be seen as a valuable additional option within the filed of spinal surgery.