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>> Hi, I'm Dr. Lee,
a Spine Surgeon at Johns Hopkins Orthopedic Surgery.
I'm gonna talk about the Complex Endoscopic Spine Surgeries
More than Simple Disc surgeries.
I have nothing to disclose, related to this topic.
Endoscopic spine surgeries, have been,
for, simple disc surgeries.
But, we have more conditions
like, recurrent disc herniation
or, thoracic spine disc,
and the spinal stenosis more commonly
and some patients need a spine fusion procedures.
For the last several years,
Endoscopic spine surgeries,
have started to cover this kind of complex conditions.
Let me show you several cases.
This is a recurrent disc herniation.
Conventional approach is going back again,
open the muscle,
to remove the bone and ligament and joint
and take disc out.
Sometimes we need a fusion surgery,
because of extensive bone resection
but, we did endoscopic approach,
it's not going to the back again, instead,
we access the spine, from the outside,
And, the shape of the bone, from the outside of the spine
and, expose a nerve root and disc herniation very safely.
And, this is a surgical video, the operating room.
So, it can visualize the disc herniation
and nerve root, very well.
So, these are the pictures,
showing the ruptured disc fragment
and the skin incision,
the old midline skin incision
and the new endoscopic seven millimeter incision.
So next case, is thoracic spine disc herniation,
eight and nine.
Is a pinching spinal cord here.
Traditional procedure, is going to midline,
open the muscle,
cutting the ligament and bone laminectomy
and put screws and fusions, but,
with a small, narrow walking sleeve
with endoscopic procedure,
we could access the disc herniation and spinal cord well,
and, we could decompress that spinal cord very safely
without extensive exposure
or, some such confusion procedures.
Okay, and this is a skin incision,
so, it's a little bit off-center of the spine
with a seven millimeter, working incision.
This patient has Lumbar spinal stenosis,
with ruptured disc, is about migration.
This is the MRI.
We did the endoscopic decompression procedure,
as a, identical to the open procedure,
like a laminectomy above and below.
And the compression of the ligaments
compressing the nerve structure,
at the central part,
and, until we make a good decompression
is a, same like open laminectomy procedure.
And we can access all the way out to the,
the other side of the spine.
And we can remove the disc herniation
and the, framing of the compression
until we can see the nerve root into the other side.
So, in terms of meticulous decompression
this is better than open compression
or decompression procedures.
So, this is a nerve root on the other side,
and, this is the intraoperative x-rays
which shows that we can access
the other side of the spine very nicely.
At the last case,
is a, this patient has a big disc herniation
with underlying severe spinal stenosis,
but, needs the fusion surgery
because of unstable at the four, five joint
So, with endoscopic approach,
we can finish the decompression
procedure is a, it's also very similar,
like open procedure,
but, everything's done by a seven millimeter
or working sleeve with the endoscopy.
So, cutting the bone spur and the ligament
and any structures pushing the nervous structure,
and, can finish the decompression,
then, clean the fusion bed,
and place the screws and cages and bone graft
to finish the fusion process.
And, this is the limb of the disc material,
and this a surgical incision,
and one inch on both sides.
Okay, this is still,
showing the decompression procedure with endoscope.
So, now we can visualize the nervous structure very well.
Okay, it shows a good decompression.
Endoscopic spine surgery,
has very strong advantages,
like a smaller skin incision,
less tissue damage and blood loss,
and the minimum surgical pain and early recovery.
And, these are,
not sour grapes anymore,
with modern advanced endoscopic surgical techniques.
We'll do the best, to provide the highest level
of spine care, at Johns Hopkins.
If you or your patient needed more information,
or have any questions,
you can contact my information,
we can provide more information in detail.
Thank you very much.
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