In close collaboration with spine specialist Dr. med. univ. Bertagnoli has created a new instrument for the treatment of herniated discs and stenotic intervertebral foramen. The instrument combines a 2.7 mm diameter fiberscope with a working channel for tissue removal using a laser probe in a single bending end guide tube with an outer diameter of only 4.0 mm. The operating sleeve allows for the suction of the vaporized tissue.
The difference between the spinoscope and conventional neurosurgical instruments
The existing instruments used for percutaneous operations for intervertebral disc herniation, in most cases, are rigid, have a mostly direct design, and allow intradiscal decompression in the r-a-direction only indirectly. They do not give direct access to a herniated disc. Endoscopically controlled surgery for a herniated disc is possible, usually through a two-portal approach.
Foraminoscopic decompression with straight and rigid instruments is very limited and does not create either intraforaminar access or access to L5 / S1. With these methods, control over the movement of instruments is not available. Existing bendable instruments do not provide sufficient soft tissue resistance.
Advantages of the spinoscope over previous methods:
- Controlled movement of the guide tool in millimeter steps. The instrument is fixed on a movable console on the operating table; this ensures the movement of the spinoscope, its constituent optical components, and the fiber in all directions and their fixation in any position separately.
- Flexible end with high mechanical resistance to soft tissues and a bending angle of up to 90 °. This enables both intradiscal and foraminoscopic use of the spinoscope and provides better access not only to the middle of the Annulus Fibrosus but also to the L5 / S1.
- Intra- and non-disc access under endoscopic control using a single instrument.
- Single-portal access with less risk to the patient compared to dual-portal access.
Comparison of foraminal and itralaminar (contralateral) foraminotomy:
Percutaneous endoscopic transforaminal lumbar foraminotomy
Percutaneous endoscopic intralaminar lumbar foraminotomy
|Mastering the method||Relatively fast||Long|
|Decompression of the lateral depression and subarticular region||Impossible without the risk of damage to the facet joint||Satisfactory|
|Decompression of the extraforaminal region||Satisfactory||Impossible|
|When applied||"Soft" disc herniation||Calcified disc, degenerative stenosis of the spinal canal, hypertrophy of the facet joints, synovial cyst of the facet joint|
Application of the spinoscope in endoscopic percutaneous laser discectomy
The Spinoscope is an endoscopic system developed for intra- and non-disc treatment of herniated and degeneration of the intervertebral disc, as well as spinal foraminal stenosis of the lumbar, thoracic and cervical spine using a laser.
The spinoscope is mounted on a holder that allows the surgeon to guide a flexible 0.6 mm laser probe with exceptional precision to the pathological site of the disc.
The endoscopic optical system allows the laser probe and light guide to be moved within the disc under direct visual control with millimeter precision forward and backward. The angle of deflection of the end of the probe/fiber can be set from 0 ° to 90 °.
Several patients have been successfully treated with a spinoscope on several parts of the spine:
- A. Endoscopic lumbar laser decompression of the intervertebral disc The light guide was inserted under visual control into the intervertebral disc. The laser resulted in sufficient detachment and puckering of the material of the intervertebral disc (laser thermoplasty of the disc), due to which decompression was successful.
- B. Endoscopic discectomy of the cervical and thoracic spine The intervertebral disc material was removed through the working canal using mechanical grasping forceps. For additional modulation of the tissue using a laser, a spinoscope was inserted through the same operating cannula and fixed with a fastening.
- C. Endoscopic foraminoscopy of the thoracic and lumbar spine The intervertebral disc material was removed through the working canal using mechanical grasping forceps. Through the same working channel, the spinoscope was introduced and fixed through fastening. The bent end was brought to the arch of the hole and the bone material was separated using a laser. Decompression with the opening of the stenotic opening (foraminoplasty) was successfully performed.
Abstract: Spinoscope is a useful, state-of-the-art instrument for various purposes within the framework of minimally invasive surgery of the intervertebral disc and spine, not only as an independent technology but also in combination with mechanical instruments.