Minimally Invasive Techniques In Disc Surgery:

Ibrahim Elsayed Hassan Kaamar

Back and neck pain is acommon musculoskeletal disorder affecting about 80%of people at some point in their lives it accounts for more sick leave and disability than any other medical conditionPotential sources of back pain include the intervertebral disc disorders such as disc degeneration disc herniation and discitis research on the pathophysiology of back pain and radiculopathy is integral to developing new management strategies after confirming diagnosis by the suitable modalities (x-ray, ct, mri, and laboratory studies)strategies of management include conservative methods ranging from self care activity control physiotherapy and medications the last choice of minimalism or less invasive surgeries invade the field of spine surgery include the disc surgery leading to open anew horizon of less morbidity and include apronounced socio-economic effect by decreasing the inpatient stay time recovery time and improvement of life quality.Minimally invasive spine surgery has been infulanced by advances in lasers endoscopy and image guidance systems the technique used in management of disc disorder depens on the site and technique used in management of desc disorders depend on the site and extent of the pathology the following techniques are explained in detail in this essay:*cerical disc disorders treated by various minimally invasive techniques as posterior minimally approach using endoscope reaching the desired level by image intensifier equipment then use of expendable dilator via which the endoscope used to perform foraminotomy and discectomy.Another technique used to reach the cervical disc is the anterior minimally invasive approach which like the conventional open epproach but by using mini access technique to decrease the post operative morbidity*thoracic disc disorders can be treated by :-anterior mini trans thoracic approach to reach level from t5-10,the level is localized then portals opening made to facilitate the reach to the disc for discectomy.Minimally invasive thoracic micro discectomy can be done using mini access technique assisted by endoscope and fluoroscopy to determine the level and mange the disc disorder.*lumbar disc treated by variable techniques such as :Transforaminal endosocopic discectomy the portal of the endoscope is placed properly by the assistsnce of the fluoroscopy to reach through the foramin in the safe triangular zone (kambins triangle to make discectomy-also fusion can be done by mnimally invasive way by using of bulls eye technique can technique and assistance of fluroscopey.Percutanique and be done by mini access to reach the disc and make nucleoplasty by electro thermal coblation-laser technology used to perform discectomy using yag laser and professor choy put its first rules of use.Minimally invasive spinal procedures can be performed effectively in the cervical and lumbar spine to treat avarity of spinal disorders however thes techniques can only be applied safely after a through understanding of spinal anatomy appropriate clinical instruction and an appreciation of poteneial complication patients should be advised of possible complication especially dural tears that may require additional treatment and than although theses procedures are minimally invasive they nonetheless carry similar risks to open procedures may of these procedures have steep learning curves and required additional training to master including fellowship training cadaveric work shop and animal lab study however once mastered these techniques can result in a significant reduction of complication and postoperative pain and discomfort and return patients ti their activities of daily living sooner than standard open more conventional procedures.