Article Figures & Data
Figures
- Figure 1
T2-weighted postoperative axial magnetic resonance images (MRIs) are shown to illustrate the extent of postoperative edema and fatty muscle degeneration following a full endoscopic interlaminar directly visualized videoendoscopic discectomy decompression (A, B) vs a traditional translaminar minimally invasive microsurgical decompression employing the operating microscope and a tubular retractor system (C, D). MRIs of study patients with symptomatic herniated disc were obtained at 4 days (A, C) and 1 year postoperatively (B, D). These exemplary postoperative images corroborate this study’s objective cross-sectional area measurements following both procedures by illustrating more edema immediately postoperatively with the standard microsurgical dissection (A vs C) and more atrophy of the paraspinal muscle not just on the approach side but also on the opposite nonsurgical side due to denervation-induced atrophy at 1 year postoperatively (B vs D) when compared with the endoscopic decompression. The observed atrophy and fatty degeneration on the nonsurgical side suggest functional segmental multifidus cross-innervation between both sides.
- Figure 2
Clinical example of interlaminar endoscopic approach to the L5-S1 motion segment for a symptomatic herniated disc (A, D). First, the ligamentum flavum is removed (B). Then, the traversing nerve root is retracted with the beveled tip of the tubular working cannula before, and annulotomy is made (C). The alternative posterior translaminar microsurgical dissection and decompression are performed with a tubular retractor system (E). The discectomy is performed following medial facetectomy (F).
- Figure 3
-weighted axial magnetic resonance imaging (MRI) image sequences obtained from patients with symptomatic lumbar disc herniations who underwent either microsurgical discectomy (A-C) or interlaminar endoscopic discectomy decompression (D–F). The MRI panels show the defect zone created by the 2 different surgical techniques. Preoperative measurements (A, D) were compared with measurements done on postoperative MRI images obtained at 4 days (B, E) and 1 year postoperatively (C, F). These area measurements summarized in Table suggested a significantly smaller defect size with the endoscopic vs the microsurgical technique (P < 0.001).
- Figure 4
T2-weighted axial magnetic resonance image (MRI) sequences obtained from a 74-year-old patient with symptomatic left L4/5 extraforaminal lumbar disc herniations who underwent transforaminal endoscopic discectomy decompression. The MRI panels show the cross-sectional measurements of the paraspinal muscle zone following the transforaminal discectomy. Preoperative measurements (A) were compared to measurements done on postoperative MRI images obtained within one year from surgery (B). These area measurements summarized in Table 1 suggested no significant atrophy of the paraspinal muscles with the endoscopic transforaminal technique.
- Figure 5
T2-weighted axial magnetic resonance image (MRI) sequences obtained from patients with symptomatic lumbar disc herniations who underwent either microsurgical discectomy (A–C) or interlaminar endoscopic discectomy decompression (D–F). The MRI panels show the cross-sectional measurements of the paraspinal muscle zone following discectomy by the 2 different surgical techniques. Preoperative measurements (A, D) were compared with measurements done on postoperative MRI images obtained at 4 days (B, E) and 1 year postoperatively (C, F). These area measurements summarized in Table suggested significantly less atrophy of the paraspinal muscles with the endoscopic vs the microsurgical technique (P < 0.001). Moreover, there was more paraspinal muscle atrophy with the microsurgical technique not only on the approach side but also opposite from it, implying disruption of cross-innervation between the bilateral paraspinal muscle groups, including the multifidus muscles.
Tables
- Table
Changes in surgical defect zone and paraspinal muscle zone data obtained at 4 d and 1 y postoperatively for interlaminar endoscopy and microsurgical patients.
Surgical Technique Area Measurement Mean ± SD ΔrCSA Immediately Postoperatively ΔrCSA Within 1-y Postoperatively Microsurgery Defect zone 41.2% ± 11.8% 62.9% ± 18.3% Muscle degeneration 22.6% ± 10.3% 23.6% ± 11.8% Interlaminar endoscopy Defect zone 17.6% ± 9.4% 6.4 ± 3.2% Muscle degeneration 20.3% ± 8.6% 2.1% ± 1.9% Transforaminal endoscopy Defect zone 5.5% ± 3.7% 6.3% ± 4.5% Muscle degeneration 6.9% ± 2.8% 7.8% ± 5.1% Δ rCSA, relative cross-sectional area.
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