| WHAT IS ENDOSCOPIC ANNULOPLASTY? Annular tears in the wall of the disc are a common source of low back pain. After discography is performed to determine the location of these annular tears, an endoscope as is described under Selective Endoscopic Discectomy, is placed into the posterior aspect of the disc. Through the endoscope, the annular tears may be seen and are treated with a Holmium YAG laser and/or a radiofrequency bipolar probe used to heat the disc. Both techniques rely on the fact that collagen in the wall of the disc shrinks and twists when heated, thereby causing shrinkage of the tears and destruction of the nerves inside the disc causing pain. Normally, there are no nerves inside the intervertebral disc of the spine, but in the case of annular tears, nerves grow into these tears causing pain. Endoscopic annuloplasty (EA) can help reduce the amount of pain associated with these nerves and the chemical leakage from the discs through the annular tears. HOW IS EA PERFORMED? Using the same system as with SED, a cannula is placed into the disc, and a laser and radiofrequency device are inserted through the working channel of the endoscope, targeting the posterior part of the disc. The laser and RF device then heat the posterior disc, thererby destroying the small painful abnormal nerves within the disc. The procedure also decompresses the posterior part of the disc by removing small amounts of disc tissue thereby reducing the degree of pressure on the wall of the disc containing the annular tears. Overall, the procedure requires approximately 45 minutes of actual operating time. WHAT ARE ALTERNATIVES TO EA ? IDET, Artificial disc replacement, intradiscal glucose injections, inversion tables/VAX-D, and spinal fusion are the most common alternatives to EA. There are advantages and disadvantages to each. Endoscopic annuloplasty permits a minimally invasive approach to a complex spinal problem without interfering with other potential open invasive surgeries such as fusion or artificial disc implantation. WHAT ARE THE POTENTIAL COMPLICATIONS OF EA? The same complications as SED plus the potential for disc space narrowing and annular degradation are possibilities long term. WHAT ARE THE RESULTS OF EA? Early Results: Good to Excellent results 83% (South Med J 2000 Sep;93(9):885-90 Marks RA Transcutaneous lumbar diskectomy for internal disk derangement: a new indication.) Late Results 2 years: Good to Excellent 47% 1 level; 41% 2 levels Spine J. 2004 Sep-Oct;4(5):564-73. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. |
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| Endoscopic Annuloplasty |
