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Rome Rehabilitation 2011 Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D. LA VIA ENDOSCOPICA INTRAFORAMINALE NEL TRATTAMENTO DELLE ERNIE DISCALI.

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Presentation on theme: "Rome Rehabilitation 2011 Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D. LA VIA ENDOSCOPICA INTRAFORAMINALE NEL TRATTAMENTO DELLE ERNIE DISCALI."— Presentation transcript:

1 Rome Rehabilitation 2011 Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D. LA VIA ENDOSCOPICA INTRAFORAMINALE NEL TRATTAMENTO DELLE ERNIE DISCALI LOMBARI Relatore : Luigi DOrazio Medicina del dolore A.O. San Camillo-Forlanini

2 The TESSYS-Concept Operation of lumbar disc herniations via lateral, transforaminal, endoscopic Approach

3 The TESSYS-Concept Indications Radiologic confirmation of lumbar herniated discs using MRI- or CT with clinical signs of nerve root compression

4 Foraminal Approach: Lumbar Spine Adjunct to Traditional Surgery Preferred for foraminal and extraforaminal HNP Preferred for foraminal and extraforaminal HNP Allow access to these pain generators: Allow access to these pain generators: Disc Disc Exiting nerve Exiting nerve Traversing nerve Traversing nerve Epidural space Epidural space Superior facet Superior facet Axilla containing the DRG Axilla containing the DRG Foraminal osteophytes Foraminal osteophytes Visualizes the Hidden Zone Foraminal of MacNab Visualizes the Hidden Zone Foraminal of MacNab Hidden Zone

5 The TESSYS-Concept Transforaminal puncture ofTransforaminal puncture of the disc space at the medial pedicular plane Entry point at the skin aboutEntry point at the skin about 8 to 18 cm from the midline 8 to 18 cm from the midline

6 The TESSYS- Concept The direction of the trajectory depends on the specific localization of the disc herniation

7 The TESSYS-Concept Discography or chromography and insertion of the guide wire

8 The TESSYS-Concept Stab incision at the entryStab incision at the entry point on the skin and insertion of the guiding rodinsertion of the guiding rod (angled or straight) into the neuroforamen

9 The TESSYS-Concept If necessary enlargement of the neuroforamen using guiding tubes and crown reamers (5, 6.5, 7.5 mm Ø) to remove parts of the facet joint

10 The TESSYS-Concept Advancement of fenestrated working tube (outer diameter 7.5 mm) over the red guiding tube and insertion of the foraminoscope

11 The TESSYS-Concept Viewing angle 30°Viewing angle 30° Outer diameter: 6,3 mmOuter diameter: 6,3 mm Working channel: 3,7 mmWorking channel: 3,7 mm Length: 174 oder 208 mmLength: 174 oder 208 mm

12 The TESSYS-Concept Removal of disc materialRemoval of disc material using forceps Application of theApplication of the radiofrequency probe to arrest bleeding

13 The TESSYS-Concept NeuroforamenPedicle Facet joints Spinous process Spinal canal Disc space Thecal sac and nerve roots Anatomic considerations

14 The TESSYS-Concept Anatomic considerations

15 The TESSYS-Concept Radiologic landmarks

16 The TESSYS-Concept Patient positioning In prone or lateral position in analgo-sedation or general in analgo-sedation or generalanesthesia

17 The TESSYS-Concept Requirement in the OR Radiolucent table and C-arc in ap and lateral view Optimal arrangement of monitors and instruments

18

19

20 Amount of removed disc material

21 Wound closure in subcutaneous fashion

22 The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

23 The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

24 The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

25 The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

26 1)Non problemi di sanguinamento 2) Ridotte complicanze( danno nervoso,trombosi,infezioni) 3) Possibile in paz. obesi< BMI ) Riabilitazione più rapida 5) Nessuna formazione di aderenze post-operatorie 6) Anestesia locale e sedazione 7) Non crea instabilità 8) Consente di eseguire la foraminotomia 9(Day- Surgery) 10)E' una piattaforma per futuri trattamenti chirurgici discali VANTAGGI The TESSYS-Concept

27 Incidence of Complications 3.5% Yeung AT, Tsou PM :Spine Vol 27 April 2002 Gradual decrease with avoidance experience Dysesthesias 5%-15% (Most common, usually temporary, not completely avoidable!) Dysesthesias 5%-15% (Most common, usually temporary, not completely avoidable!) DRG, Circulatory changes, furcal nerves, anomalous nerves DRG, Circulatory changes, furcal nerves, anomalous nerves Persistent sensory deficit 1% Persistent sensory deficit 1% Persistent motor weakness 2% Persistent motor weakness 2% Dural tears do not need repair Due to no Surgical approach dissection Discitis.03% Discitis.03% Dural tear 1% Dural tear 1% Thrombophlebitis.5% Thrombophlebitis.5% Bowel injury 1/3,000 (.003%) Bowel injury 1/3,000 (.003%) Vascular injury 0% Vascular injury 0%

28 CASISTICA L4-L5 10 F 7 M 3 L5-S1 5 F 2 M 3 Tot 15 Lateralità Dx 8 Sn 6 Mediana 1 The TESSYS-Concept

29 COMPLICANZE Disestesie temporanee 1 (regredite con terapia medica) Irritazione temporanea del nervo 1 Interventi interrotti 1 (per anomalia del nervo Interventi convertiti con altro approccio 1 ( approccio mediano per via endoscopica L5- S1) The TESSYS-Concept

30 Due to: Due to: Conclusion minimal invasivity minimal invasivity good clinical results good clinical results low complication rate low complication rate the Tessys-method represents an : attractive and efficient treatment modality for attractive and efficient treatment modality for median to extraforaminal positioned lumbar disc median to extraforaminal positioned lumbar disc herniations even at the level L5/S1 and reduces the indication for open disc surgery herniations even at the level L5/S1 and reduces the indication for open disc surgery The TESSYS-Concept

31 GRAZIE


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