Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation

Summary

Here, we present a protocol to describe the full endoscopic interlaminar approach (FEILA) technique, including every cutoff step required to reach technical proficiency. FEILA is a surgery with a relatively steep learning adaptation. Despite this, any surgeon capable of microdiscectomy can perform FEILA with enough practice and suitable patient selection.

Abstract

The full endoscopic interlaminar approach (FEILA) is a minimally invasive technique for lumbar discectomy. It has multiple advantages over other conventional discectomy methods, including less traumatization of the soft tissues, fewer complication rates (dural injury, bleeding), rapid rehabilitation, quick return to daily life activities, and preferable cosmetic results. FEILA is a surgery with a relatively steep learning adaptation. Endoscopic surgery is a closed tubular approach, and all surgical maneuvers are performed within a uniportal single working channel. Also, the technique has not yet been standardized and well-documented. Therefore, the early learning stages of this technique may not be easy for most surgeons. Despite these, FEILA is easy, and the operation length is comparable to and even shorter than other techniques of lumbar discectomy. FEILA for lumbar discectomy could be considered a safe and effective alternative procedure for paracentral L5-S1 disc herniation. Here, we describe the technique of FEILA, including every cutoff step required to reach technical proficiency for surgeons who want to start applying this approach.

Introduction

Lumbar degenerative disc disease is an anatomical and morphological change causing clinical complaints¹. Surgery is the appropriate treatment in cases that do not respond to conservative treatments². Conventional surgeries have been used, but they have disadvantages such as prolonged hospital stay, high amount of tissue damage, delayed mobilization, and risk of epidural fibrosis and instability. Because of these disadvantages, researchers have tried to develop less invasive methods. The full endoscopic (interlaminar-transforaminal) technique with posterolateral access evolved out of this².

Protocol

The study protocol was approved by the institutional review board of the Istanbul Faculty of Medicine. Written consent was obtained from the patients before the surgical procedure.

1. Preoperative procedures

1. Perform the procedure under general anesthesia with an anesthetist. Set the endoscopic and optic instruments, and C-arm devices in the operation room.
2. Ensure the following tools are available for the procedure; dilator, working sleeve, endoscope with .......

Discussion

The results of recent studies depict the possibility of sufficient decompression via FEILA; these results are equal to those of traditional methods. Also, the advantages of the significant relief of back pain, faster recovery after surgery (short period of hospital stay), fewer complications, lower recurrence rate, minimizing soft-tissue disruption (small incision, less muscle cutting, less blood loss), and reducing segment instability have been shown^10,1.......

Materials

Name	Company	Catalog Number	Comments
Burr Oval Ø 5.5 mm	RiwoSpine	899751505	PACK = 1 PC, WL 290 mm, with lateral protection
C-arm	ZIEHM SOLO		C-arm with integrated monitor
Dilator ID 1.1 mm OD 9.4 mm	RiwoSpine	892209510	For single-stage dilatation, TL 235 mm, reusable
Endoscope	RiwoSpine	892103253	20° viewing angle and 177 mm length with a 9.3 mm diameter oval shaft with a 5.6 mm diameter working channel
Kerrison Punch 5.5 mm x 4.5 mm WL 380 mm	RiwoSpine	892409445	60°, TL 460 mm, hinged pushrod, reusable
Punch Ø 3 mm WL 290 mm	RiwoSpine	89240.3023	TL 388 mm, with irrigation connection, reusable
Punch Ø 5.4 mm WL 340 mm	RiwoSpine	892409020	TL 490 mm, with irrigation connection, reusable
Radioablator RF BNDL	RiwoSpine	23300011
RF Instrument BIPO Ø 2.5 mm WL 280 mm	RiwoSpine	4993691	for endoscopic spine surgery, flexible insert, integrated connection cable WL 3 m with device plug to Radioblator RF 4 MHz, sterile, for single use
Rongeur Ø 3 mm WL 290 mm	RiwoSpine	89240.3003	TL 388 mm, with irrigation connection, reusable
Working Sleeve ID 9.5 mm OD 10.5 mm	RiwoSpine	8922095000	TL 120, distal end beveled, graduated, reusable