>> Hi, my name is Dr. Sang Lee.
I'm a spine surgeon.
I'm specializing endoscopic spine surgery at Johns Hopkins.
So, let me introduce endoscopic spine surgery.
Today, it is the least invasive spine surgery.
So, I have nothing to disclose related to this topic.
Endoscopic surgery is well established
and standard procedure in a lot of surgical field
in modern medicine.
For example, many procedures in the laparoscopic surgery
or arthroscopic joint surgery are good examples,
but sometimes we are doing very rare endoscopic surgery
like intrauterine surgery.
MIS, that means minimally invasive surgery,
is very popular these days for small incision,
less bleeding, less muscle damage, and better outcome.
So, let me show you spinal endoscopy.
This is the spinal endoscopy,
so it looks like a regular joint endoscopy, arthroscopy,
but it has a working channel inside,
so through this space,
we can do a lot of procedures like disc removal,
or bone spur removal, or decompression of spinal stenosis.
This is a type of spinal endoscopic surgery.
So, to remove the disc here,
we have to access through the back,
so that means that we need some necessary muscle damage
and ligament damage that's innocent structures.
But instead of that, the endoscopy make
a small incision side of the spine
and access the disc herniation and remove the disc.
This is the picture during surgery.
We make a small, tiny porthole the side of the spine,
and working on the spinal canal, and this is a video clip.
It shows procedure of the disc removal
using spinal endoscopy.
So, after disc removal, you can see the epidural space
and freed its nerve root there.
Okay, so another approach is the interlaminar approach.
This is a very identical to conventional open procedures,
but make a small incision in the mid line of back,
and go directly to the spine.
So, advantage of this procedure is
indication can be expanded to big disc herniation,
migrated disc herniation, or more complicated cases.
This video clips shows interlaminar discectomy procedure.
So we remove the laminectomy like exactly the same way
to open open procedures, and access to the epidural space,
and protect the nerve root and remove the disc out.
That's almost 100% same procedure
like open microscopic discectomy.
This is a cervical spine case.
This patient had a conventional
anterior cervical spine surgery several years ago,
and started to have a new arm pain.
MRI showed a new disc herniation
a little bit below the prior fusion,
so the conventional approach is to go protogain
and do the revision access
and extension of fusion after disk removal,
but we made a decision to do endoscopic surgery
for this patient.
This is a procedure during surgery.
So, with the endoscopic access
we can find the nerve root and ruptured disc fragment
and we could remove the big disc herniation
without any nerve damage and minimal surgical mobility.
This a ruptured disc and this is a surgical scar.
It's less than one centimeter
and the minimum post, after surgical pain
So, now we're expanding indications
of endoscopic spine surgery
like lumbar spinal stenosis or revision surgeries,
some cases of thoracic disc herniation and
cervical spinal cord compressions.
So, if you or your patient need endoscopic surgery
or any help, do not hesitate to contact me,
to email me, or to call this number.
Thank you very much.