Percutaneous treatment of intervertebral disc
Percutaneous treatment of intervertebral disc consists of two main steps: an optimal access and destruction or removal of material of an intervertebral disc. For the destruction or removal of material of the intervertebral disc exist in addition to the following features hemonukleoliza:
- laser vaporization
- automated discectomy
- mechanical removal with forceps exciting
Instrument for percutaneous treatment of intervertebral disc.
Differences in the methods put the surgeon faced with the need to distinguish between latent herniated disc (contained herniated disc) and open (non contained herniated disc). When hidden herniated disc treatment is to reduce intradiscal pressure by reducing the mass of the Nucleus pulposus.
For this there are all of the above possibilities. Access is in the dorsolateral direction caudally and dorsally by a clearly visible on the computer tomography nerve root.
With open hernia with a torn Anulus fibrosus of intervertebral disc material, or acts under the posterior longitudinal ligament (subligamental hernia), or it is freely placed in the epidural space when the longitudinal ligament is also torn (sequestered hernia).
In contrast to the non-selective intradiscal reduce material with latent herniated disc that requires the selective removal of the speaker of the material of the intervertebral disc., And the planning of access is important.
- In the pre-scheduled and designated locations of access under CT control (control using computed tomography) is performed using the puncture needle puncture. The needle is inserted under CT control until Ligamentum Flavum. With the simultaneous injection of physiological solution of sodium chloride puncture needle is inserted next to the speaker of the material of the intervertebral disc. After entering the string 0,8 mm and removing the puncture needle is introduced at first cautiously to strengthen until the hernia extending sleeve, and then expanded access through the expander. Above it can now be posted operating cannula with an outer diameter of 5.5. In addition to CT control the correct position of the operating cannula can be verified endoscopically. For this purpose there Optics HOPKINS ® 30 ° and 0 °. After entering the endoscope tube feeding of wash solution through a connection with LUER lock controlled by a washing tube so that the monitor had a clear image. After validation of the cannula as in CT-image and with the help of an endoscope can proceed to remove the public of the material of the intervertebral disc. Outdoor sequestration can be removed now with the exciting optical forceps. When subligamental open herniated disc should be disclosed first by trephine posterior longitudinal ligament. After disclosure of an open herniated disc is removed and then with the help of spectacular nutcracker. If in addition to a herniated disc there is a noticeable warping Anulus fibrosus, we spend extra, usually intradiscal laser vaporization with a laser tube under optical control.
- In this case, treatment is simply to reduce intradiscal pressure by reducing the mass of the Nucleus pulposus. Access to the intervertebral disk in the same way as in the above open hernia. Because of the simplicity of the method and the minimal risk of complications, we are holding this reduction in tissue by laser vaporization with a laser tube under optical control.
If you have any questions, you can specify them with our neurosurgeon or a neurologist on the phone: (499) 130–08–09
- Endoscopic microdiscectomy
- Endoscopic treatment of fractures of the C2 vertebra
- Endoscopic treatment of carpal tunnel syndrome
- Endoscopic treatment of cubital canal syndrome
- Endoscopic treatment of ulnar nerve compression syndrome
- Fixation of the spine in spondylolisthesis, reducing the height of the intervertebral disc
- Fusion and fixation spinal surgery
- Vertebroplasty and kyphoplasty with the "SKy" intravertebral bone expander system
- Laser reconstruction of intervertebral discs
- Percutaneous nucleotomy with laser vaporization
- Percutaneous posterolateral foraminoscopy
- Retractor for a herniated disc
- Technique of sampling and blending sponge layer (Spongiosa)
- Treatment of a herniated disc and stenosed holes