Clinical studies in full-endoscopic spine surgery

 

An Extreme Lateral Access for the Surgery of Lumbar Disc Herniations Inside the Spinal Canal Using the Full-Endoscopic Uniportal Transforaminal Approach-Technique and Prospective Results of 463 Patients 

Sebastian Ruetten, MD, PhD, Martin Komp, MD, PhD, and Georgios Godolias, MD, Prof 

SPINE Volume 30, Number 22, pp 2570-2578 ©2005, Lippincott Williams & Wilkins, Inc. 

 

Study Design.Prospective study of patients with lumbar herniations who were operated on with a full-endoscopic uniportal transforaminal approach using an extreme lateral access.

An_extreme_lateral_access.pdf
PDF 14 MB

Bilateral Spinal Decompression of Lumbar Central Stenosis with the Full-Endoscopic Interlaminar Versus Microsurgical Laminotomy Technique: A Prospective, Randomized, Controlled Study

Martin Komp, Dr. med., Patrick Hahn, Dr. med., Semih Oezdemir, Dr. med., Athanasios Giannakopoulos, Dr. med., Roderich Heikenfeld, Dr. med., Richard Kasch, Dr. med., Harry Merk, Prof. Dr. med., Georgios Godolias, Prof. Dr. med., and Sebastian Ruetten, Priv. Doz. Dr. med. habil

Pain Physician 2015; 18:61-70 • ISSN 1533-3159

Background: Extensive decompression with laminectomy, where appropriate, is often still described as the method of choice when operating on degenerative lumbar spinal stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the surgical advantages they offer and the benefits for rehabilitation. One key issue when operating on the spine was the development of instruments to provide sufficient bone resection under continuous visual control. This was achieved by using endoscopes for operations carried out in cases of spinal canal stenosis. 

Bilateral_spinal_decompression.pdf
PDF 310 KB

Bilateral Operation of Lumbar Degenerative Central Spinal Stenosis in Full-endoscopic Interlaminar Technique with Unilateral Approach

Martin Komp, Dr. med., Patrick Hahn, Dr. med., Dr. med., Harry Merk, Prof. Dr. med., Georgios Godolias, Prof. Dr. med., and Sebastian Ruetten, Priv. Doz. Dr. med. habil

J Spinal Disord Tech, Volume 24, Number 5, July 2011

Study Design: Prospective study of the patients with degenerative spinal central stenosis, operated bilateral in a full-endoscopic unilateral technique.

Bilateral_Operation_of_Lumbar
PDF 271 KB

Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical 
disc herniations 

Martin Komp, Dr. med., Patrick Hahn, Dr. med., Dr. med., Harry Merk, Prof. Dr. med., Georgios Godolias, Prof. Dr. med., and Sebastian Ruetten, Priv. Doz. Dr. med. habil

International Orthopaedics (SICOT) DOI I 0.1007 /s00264-008-0684-y 

Abstract: Anterior cervical decompression and fusion (ACDF) is the standard for cervical discectomies. With the full-endoscopic anterior cervical discectomy (FACD) a minimally invasive procedure is available. The objective of this prospective, randomised, controlled study was to compare the results ofFACD with those of ACDF in rnediolateral soft disc herniations. A total of 103 patients with ACDF or FACD were followed up for two years. In addition to general parameters specific measuring instmments were used. Post-operatively 85.9% of the patients no longer had aim pain, and I 0.1 % had occasional pain. There were no significant clinical differences between the decompression with or without fusion. The full-endoscopic technique afforded advantages in operation technique, rehabilitation and soft tissue injury. The recorded results show that FACD is a sufficient and safe alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention. 

Full-endoscopic anterior decomp. vs convent.pdf
PDF 8 MB

Full-Endoscopic Cervical Posterior Foraminotomy for the Operation of Lateral Disc Herniations Using 5.9-mm Endoscopes

A Prospective, Randomized, Controlled Study

Sebastian Ruetten, MD, PhD, Martin Komp, MD, PhD, Harry Merk, MD,† and Georgios Godolias, MD‡

SPINE Volume 33, Number 9, pp 000 – 000 ©2008, Lippincott Williams & Wilkins

Study Design: Prospective, randomized, controlled study of patients with lateral cervical disc herniations, operated either in a full-endoscopic posterior or conven-tional microsurgical anterior technique.

Full-Endoscopic_Cervical_Posterior.pdf
PDF 1 MB

Full-Endoscopic Interlaminar and Transforaminal
Lumbar Discectomy Versus Conventional Microsurgical Technique

A Prospective, Randomized, Controlled Study

Sebastian Ruetten, MD, PhD, Martin Komp, MD, PhD, Harry Merk, MD,† and Georgios Godolias, MD‡

SPINE Volume 33, Number 9, pp 000 – 000 ©2008, Lippincott Williams & Wilkins

Study Design: Prospective, randomized, controlled study of patients with lumbar disc herniations, operated either in a full-endoscopic or microsurgical technique.

Full-Endoscopic_Interlam_and_Transform.pdf
PDF 785 KB

Full-endoscopic Operations of the Spine in Disk Herniations and Spinal Stenosis

Sebastian Ruetten, MD, PhD

Full-endoscopic Operations of the Spine in Disk Herniations and Spinal Stenosis RUETTEN

Orthopaedic Surgery SURGICAL TECHNOLOGY INTERNATIONAL XXI

Abstract: degenerative constrictions of the spinal canal with compression of neural elements arise as a result of  bony, disk, capsular, or ligament structures. The most frequent causes are disk herniations and spinal stenoses. The lumbar and cervical spine is the most prominent cause. After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical, microscopically assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region, while in the cervical spine microsurgical, microscopically assisted anterior decompression and fusion are standard. Both procedures demonstrate good clinical results but present problems associated with the operation. Decompressions in the area of the spine must be carried out under continuous visualization and must entail the possibility of adequate bone resection. Taking this into account, completely new endoscopes and instrument sets were developed for full-endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches for the lumbar spine and the posterior and contralateral anterior approaches for the cervical spine. The possibilities and results of comparable, established standard rocedures were used as a benchmark in the course of clinical validation. The development of surgically cre-ated approaches and the new rod lens endoscopes combined with appropriate instrument sets have laid the technical foundations for full-endoscopic operation in the lumbar spine on all primary and recurrent disk herniations inside and outside the spinal canal and on spinal stenoses. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the relevant approaches depends on anatomical and pathological inclusion and exclusion criteria. The clinical results of standard procedures are achieved, which must be regarded as a minimum criterion for the introduction of new technologies. On the basis of EBM criteria, it can be established that using the full-endoscopic techniques developed, adequate decompression is achieved in the defined indications with reduced traumatization, improved visibility con-ditions, and positive cost benefits. Today, full-endoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery. 

Full-endoscopic Op. of the Spine pdf
PDF 4 MB

A New Full-Endoscopic Technique for Cervical Posterior Foraminotomy in the Treatment of Lateral Disc Herniations Using 6.9-mm Endoscopes: Prospective 2-Year Results of 87 Patients

PhD. Ruetten , M. Komp , H. Merk\ G.Godolias

Ruetten Set al. A New Full-Endoscopic Technique ... Minim lnvas Neurosurg 2007: 50: 219-226

Abstract: Anterior ceivical decompression and fusion (ACDF) is the standard procedure for operation of ceivical disc herniations with radicular arm pain. Mobility-preseiving posterior forami-notomy is the most common alternative in the case of a lateral localization of the pathology. Despite good clinical results, problems may arise due to traumatization of the access. Endoscopic techniques are considered standard in many areas, sirice they may offer advantages in surgi-cal technique and rehabilitation. These days, all disc herniations of the lumbar spine can be oper-ated in a full-endoscopic technique. The objec-tive of this prospective study was to examine the technical possibilities of full-endoscopic poste-rior foraminotomy in the treatment of ceivical lateral disc herniations. 87 patients were fol-lowed for 2 years. The results show that 87.4% no longer have arm pain and 9.2 % have only occasional pain. The decompression results were equal to those of conventional procedures. The operation-related traumatization was reduced. The recurrence rate was 3.4%. No serious surgi-cal complications occurred. The recorded results show that the full-endoscopic posterior forami-notomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive inteivention. 

New full-endoscoopic technique for cervical foram.pdf
PDF 13 MB

A New Full-Endoscopic Technique for the Interlaminar Operation of Lumbar Disc Herniations Using 6-mm Endoscopes: Prospective 2-Year Results of 331 Patients

Sebastian Ruetten, MD, PhD, Martin Komp, Georgios Godolias, MD‡

Ruetten Set al. A New Full-Endoscopic Technique for ..• Minim lnvas Neurosurg 2006; 49: 80-87

Abstract: Even with good results, conventional disc operations may result in consecutive damage due to traumatisation. Endoscopic tech-niques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. The transforaminal operation is the most common full-endo-scopic procedure in surgery of the lumbar spine. It is frequently necessary to reach the spinal canal directly in order to achieve sufficient resection of lumbar disc herniations. Even in using a lateral approach, the authors recognise the clear limitations of the transforaminal procedure. The objective of this prospective study was to examine the technical possibility of a full-endo-scopic interlaminar access. The focus was on questions of suffi-cient decompression, as well as advantages and disadvantages of the minimally invasive procedure. 331 patients were followed for 2 years. The results show that 82 % reported no longer having leg pain, and 13 % had only occasional pain. The decompression results are equivalent to those of conventional procedures. Trau-matisation of both the access pathway and the spinal canal struc-tures was reduced. Epidural scarring was minimised. The recur-rence rate was 2.4%. No serious surgical complications were ob-served. The authors view the technique described, which offers the advantage of a truly minimally invasive procedure, as a suffi-cient and safe alternative to conventional procedures, when the appropriate indication criteria are heeded. There are technical problems because of the small instruments. In conjunction with the transforaminal procedure, this is an expansion of the spec-trum for full-endoscopic surgery of lumbar disc herniations. 

New full-endoscopopic technique for interlam.pdf
PDF 14 MB

Recurrent Lumbar Disc Herniation After
Conventional Discectomy

A Prospective, Randomized tudy Comparing Full-endoscopic Interlaminar and Transforaminal Versus Microsurgical Revision

Sebastian Ruetten, MD, PhD, Martin Komp, MD, PhD, Harry Merk, MD,† and Georgios Godolias, MD‡

J Spinal Disord Tech, Volume 22, Number 2, April 2009

Study Design: Prospective, randomized, controlled study of patients with recurrent lumbar disc herniations after conven-tional discectomy, operated either in a full-endoscopic or microsurgical technique.

Recurrent_Lumbar_Disc_Herniation_After.pdf
PDF 433 KB

Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, 
controlled study 

Clinical article 

Sebastian Ruetten, MD, PhD, Martin Komp, MD, PhD, Harry Merk, MD, and Georgios Godolias, MD‡

J Neurosurg Spine 10:476-485, 2009 

Object. Extensive decompression with laminectomy where appropriate is often still described as the method of choice in surgery for lateral recess stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. Transforaminal and interlaminar access provide 2 full-endoscopic (FE) techniques for lumbar spine surgery. The goal of this prospective randomized controlled study was to compare the surgical results for the FE technique via the interlaminar approach with those of the conventional microsurgical technique in patients with degenerative lateral recess stenosis. 

Surg.treatment lumbar stenosis.pdf
PDF 6 MB