Name: full-endoscopic isolation zone technique for the treatment of lumbar disc herniation
Uploaded: 2023-04-07T15:00:00
Description: Watch this Scientific Journal Video about Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation at JoVE.com

The protocol follows the guidelines of the Ethics Committee of Cangzhou Central Hospital (No.: 20210205). Informed consent was obtained from the patients to include them, and the data were generated as part of this study.
1. Pre-operative preparation
<ol>
	<li>Select patients according to the following inclusion and exclusion criteria.
	<ol>
		<li>Follow the inclusion criteria mentioned below:
		<ol>
			<li>Include patients with lower waist pain caused by long-term sitting, ...

<ol>
	<li>Fujii, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discogenic+back+pain:+Literature+review+of+definition,+diagnosis,+and+treatment.">Discogenic back pain: Literature review of definition, diagnosis, and treatment.</a> JBMR Plus. 3 (5), 10180 (2019).</li><li>Urits, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low+back+pain,+a+comprehensive+review:+Pathophysiology,+diagnosis,+and+treatment.">Low back pain, a comprehensive review: Pathophysiology, diagnosis, and treatment.</a> Current Pain and Headache Reports. 23 (3), 23 (2019).</li><li>Geurts, J. W., Willems, P. C., Kallewaard, J. W., van Kleef, M., Dirksen, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+chronic+discogenic+low+back+pain:+Costs+and+patients'+burden.">The impact of chronic discogenic low back pain: Costs and patients' burden.</a> Pain Research &amp; Management. 2018, 4696180 (2018).</li><li>Kallewaard, J. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discogenic+low+back+pain.">Discogenic low back pain.</a> Pain Practice. 10 (6), 560-579 (2010).</li><li>Peng, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+clinical+study+on+natural+history+of+discogenic+low+back+pain+at+4+years+of+follow-up.">Prospective clinical study on natural history of discogenic low back pain at 4 years of follow-up.</a> Pain Physician. 15 (6), 525-532 (2012).</li><li>Bydon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+fusion+versus+nonoperative+management+for+treatment+of+discogenic+low+back+pain:+A+systematic+review+and+meta-analysis+of+randomized+controlled+trials.">Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: A systematic review and meta-analysis of randomized controlled trials.</a> Journal of Spinal Disorders &amp; Techniques. 27 (5), 297-304 (2014).</li><li>Zhao, L., Manchikanti, L., Kaye, A. D., Abd-Elsayed, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+discogenic+low+back+pain:+current+treatment+strategies+and+future+options-a+literature+review.">Treatment of discogenic low back pain: current treatment strategies and future options-a literature review.</a> Current Pain and Headache Reports. 23 (11), 86 (2019).</li><li>Yagi, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advantages+of+revision+transforaminal+full-endoscopic+spine+surgery+in+patients+who+have+previously+undergone+posterior+spine+surgery.">Advantages of revision transforaminal full-endoscopic spine surgery in patients who have previously undergone posterior spine surgery.</a> Journal of Neurological Surgery, Part A: Central European Neurosurgery. , (2022).</li><li>Okada, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preoperative+planning+using+three-dimensional+printing+for+full-endoscopic+spine+surgery:+A+technical+note.">Preoperative planning using three-dimensional printing for full-endoscopic spine surgery: A technical note.</a> NMC Case Report Journal. 9, 249-253 (2022).</li><li>Zhou, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unique+complications+of+percutaneous+endoscopic+lumbar+discectomy+and+percutaneous+endoscopic+interlaminar+discectomy.">Unique complications of percutaneous endoscopic lumbar discectomy and percutaneous endoscopic interlaminar discectomy.</a> Pain Physician. 21 (2), 105-112 (2018).</li><li>Wasinpongwanich, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Full-endoscopic+interlaminar+lumbar+discectomy:+Retrospective+review+of+clinical+results+and+complications+in+545+international+patients.">Full-endoscopic interlaminar lumbar discectomy: Retrospective review of clinical results and complications in 545 international patients.</a> World Neurosurgery. 132, 922-928 (2019).</li><li>Yin, J., Jiang, Y., Nong, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transforaminal+approach+versus+interlaminar+approach:+A+meta-analysis+of+operative+complication+of+percutaneous+endoscopic+lumbar+discectomy.">Transforaminal approach versus interlaminar approach: A meta-analysis of operative complication of percutaneous endoscopic lumbar discectomy.</a> Medicine. 99 (25), 20709 (2020).</li><li>Manabe, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thermal+annuloplasty+using+percutaneous+endoscopic+discectomy+for+elite+athletes+with+discogenic+low+back+pain.">Thermal annuloplasty using percutaneous endoscopic discectomy for elite athletes with discogenic low back pain.</a> Neurologia Medico-Chirurgica. 59 (2), 48-53 (2019).</li><li>Wang, L., Li, L., Cheng, C., Xue, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+percutaneous+spinal+endoscopy+&amp;#34;isolation+zone&amp;#34;+technique+for+discogenic+low+back+pain:+a+case+series+study.">The percutaneous spinal endoscopy &amp;#34;isolation zone&amp;#34; technique for discogenic low back pain: a case series study.</a> European Journal of Medical Research. 27 (1), 200 (2022).</li><li>Tonosu, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosing+discogenic+low+back+pain+associated+with+degenerative+disc+disease+using+a+medical+interview.">Diagnosing discogenic low back pain associated with degenerative disc disease using a medical interview.</a> PLoS One. 11 (11), 0166031 (2016).</li><li>Momenzadeh, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+percutaneous+laser+disc+decompression+on+reducing+pain+and+disability+in+patients+with+lumbar+disc+herniation.">The effect of percutaneous laser disc decompression on reducing pain and disability in patients with lumbar disc herniation.</a> Journal of Lasers in Medical Sciences. 10 (1), 29-32 (2019).</li><li>Zhang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+endoscope-assisted+and+microscope-assisted+tubular+surgery+for+lumbar+laminectomies+and+discectomies:+Minimum+2-year+follow-up+results.">Comparison of endoscope-assisted and microscope-assisted tubular surgery for lumbar laminectomies and discectomies: Minimum 2-year follow-up results.</a> BioMed Research International. 2019, 5321580 (2019).</li><li>Liu, K. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+percutaneous+endoscopic+outside-in+technique+to+treat+selected+patients+with+refractory+discogenic+low+back+pain.">Using percutaneous endoscopic outside-in technique to treat selected patients with refractory discogenic low back pain.</a> Pain Physician. 22 (2), 187-198 (2019).</li><li>Zuo, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+efficacy+of+biportal+endoscopy+is+comparable+to+that+of+uniportal+endoscopy+via+the+interlaminar+approach+for+the+treatment+of+L5/S1+lumbar+disc+herniation.">The clinical efficacy of biportal endoscopy is comparable to that of uniportal endoscopy via the interlaminar approach for the treatment of L5/S1 lumbar disc herniation.</a> Frontiers in Surgery. 9, 1014033 (2022).</li><li>Yuan, C., Wen, B., Lin, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+analysis+of+minimally+invasive+percutaneous+treatment+of+severe+lumbar+disc+herniation+with+UBE+two-channel+endoscopy+and+foraminal+single-channel+endoscopy+technique.">Clinical analysis of minimally invasive percutaneous treatment of severe lumbar disc herniation with UBE two-channel endoscopy and foraminal single-channel endoscopy technique.</a> Oxidative Medicine and Cellular Longevity. 2022, 9264852 (2022).</li><li>Minamide, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microendoscopic+decompression+for+lumbar+spinal+stenosis+with+degenerative+spondylolisthesis:+The+influence+of+spondylolisthesis+stage+(disc+height+and+static+and+dynamic+translation)+on+clinical+outcomes.">Microendoscopic decompression for lumbar spinal stenosis with degenerative spondylolisthesis: The influence of spondylolisthesis stage (disc height and static and dynamic translation) on clinical outcomes.</a> Clinical Spine Surgery. 32 (1), 20-26 (2019).</li><li>Yeung, A. T., Yeung, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In-vivo+endoscopic+visualization+of+patho-anatomy+in+painful+degenerative+conditions+of+the+lumbar+spine.">In-vivo endoscopic visualization of patho-anatomy in painful degenerative conditions of the lumbar spine.</a> Surgical Technology International. 15, 243-256 (2006).</li><li>Shi, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+an+in+vivo+mouse+model+of+discogenic+low+back+pain.">Development of an in vivo mouse model of discogenic low back pain.</a> Journal of Cellular Physiology. 233 (10), 6589-6602 (2018).</li></ol>

LDH is a degenerative disease of the spine that seriously affects daily life and work. The main clinical manifestations are low back pain and sciatic nerve pain. Extreme waist movements, fixed posture, and physical labor can aggravate the symptoms4,15. If conservative treatment cannot alleviate the clinical symptoms, minimally invasive methods are used to treat patients with LDH. Momenzadeh et al. used percutaneous laser disc decompression (PLDD) to treat 30 pati...

LDH is a common degenerative disease of the spine. LDH is accompanied by multifactorial changes, such as degeneration of the intervertebral disc and the surrounding structures. The interaction between multifactorial degeneration and the nervous system causes pain1. The pain of this disease manifests as low back pain and leg pain, and sometimes LDH can be related to an inability to maintain the same posture or sensory-motor disorder of the lower limbs2. The severe clinical symptoms of LDH bring great pain to the patients and represent a serious medical and social problem3,4. For patients with obvious herniated intervertebral discs or a torn annulus fibrosus, traditional conservative treatments, including drug therapy, physical therapy, and rest, cannot effectively solve their problem5. Lumbar fusion surgery is usually used to treat patients with LDH for whom conservative treatment is ineffective6. However, this surgery has a high economic cost and causes large surgical trauma and destruction of the stable structure of the spine; additionally, the postoperative improvement in low back pain, sensory-motor disturbance of the lower limbs, and lumbar motion function, etc., is sometimes unsatisfactory7. The development of FESS has not only improved the curative effects of lumbar surgery but also reduced the cost and risk of surgery8,9. However, if the nucleus pulposus is not completely removed during endoscopic surgery and the treatment of the pain-inducing factors is not comprehensive, the patient will have low back pain, dysesthesia in the lower extremities, and other adverse reactions after surgery10,11,12,13.
To avoid inadequate removal of the nucleus pulposus during endoscopic surgery and the inadequate relief of postoperative neurological dysfunction, our research team applied a modified spinal endoscopic &#34;isolation zone&#34; technique. The &#34;isolation zone&#34; technology aims to block the pain transmission pathway of the sinus vertebra nerve and sciatic nerve by removing the herniated intervertebral disc, ruptured annulus fibrosus, and hyperplastic inflammatory tissue. In addition, pathogenic inflammatory mediators on the surface of the disc and intraspinal canal are removed13. The &#34;isolation zone&#34; technique can fully decompress the unilateral compressed spinal nerves. This technical strategy is more minimally invasive and effective than traditional surgical methods.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>18 G puncture needle</td>
			<td>tong lu</td>
			<td>KB401.061</td>
			<td></td>
		</tr>
		<tr>
			<td>3.7 mm spinal endoscope</td>
			<td>joimax</td>
			<td>FS6342181C</td>
			<td></td>
		</tr>
		<tr>
			<td>4-0 nonabsorbent surgical suture</td>
			<td>Johnson &#38; Johnson</td>
			<td>WB761</td>
			<td></td>
		</tr>
		<tr>
			<td>7.5 mm working channel</td>
			<td>maxmore</td>
			<td>1001-ES04</td>
			<td></td>
		</tr>
		<tr>
			<td>Bone drill</td>
			<td>maxmore</td>
			<td>1001-BD(001-005)</td>
			<td>4 mm, 5 mm, 6 mm, 7 mm, 8 mm diameter</td>
		</tr>
		<tr>
			<td>C-arm X-ray machine</td>
			<td>GE</td>
			<td>OEC one</td>
			<td></td>
		</tr>
		<tr>
			<td>Catheters</td>
			<td>maxmore</td>
			<td>1001-DC 001</td>
			<td></td>
		</tr>
		<tr>
			<td>Expansion guide rod</td>
			<td>maxmore</td>
			<td>1001-DC 002</td>
			<td></td>
		</tr>
		<tr>
			<td>Flexible bipolar radiofrequency</td>
			<td>tian song</td>
			<td>G8002.2</td>
			<td></td>
		</tr>
		<tr>
			<td>Guide wire</td>
			<td>maxmore</td>
			<td>1001-GW 003</td>
			<td>1mm diameter</td>
		</tr>
		<tr>
			<td>Nucleus pulposus forceps</td>
			<td>maxmore</td>
			<td>1001-EF 001 003</td>
			<td>0&#176;and 15&#176;</td>
		</tr>
		<tr>
			<td>Tom Shidi locator</td>
			<td>maxmore</td>
			<td>1001-TS 001</td>
			<td></td>
		</tr>
	</tbody>
</table>

full-endoscopic isolation zone technique for the treatment of lumbar disc herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

FESS with the &#34;isolation zone&#34; strategy was adopted in this study to treat LDH, and this method effectively relieved the patients&#39; low back pain and/or sciatic nerve pain. For all the patients who underwent surgery under local anesthesia, the operation did not have to be interrupted because of unbearable pain. The VAS score, ODI index, and the excellent and good rates of the modified MacNab criteria from the previous study are shown in Table 1.
The MRI re-examinati...

Watch this Scientific Journal Video about Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation at JoVE.com

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Here, we present a protocol for the &#34;isolation zone&#34; technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

Este protocolo é uma técnica padronizada de descompressão endoscópica para nervos espinhais, o que pode garantir bom efeito clínico. Algumas instalações da tecnologia podem ser usadas para comparar simetria a todos os fatores patogênicos da LDH com poucos sintomas residuais após a cirurgia, e efeitos de tratamento mais satisfatórios. Esta técnica é de especial importância para tipos especiais de DDD, tais como, hérnia de disco calcificada e lombalgia discogênica.Esses dois tipos de doença são controversos no tratamento endoscópico. O procedimento foi demonstrado por Lu Wang e Xinbiao Yan, do Departamento de Ortopedia do Hospital Central de Cangzhou. Após a administração de anestesia local ao paciente, puncione o fundo do processo articular com uma agulha de punção calibre 18.Certifique-se de que a ponta da agulha de punção esteja localizada na borda interna do processo articular na radiografia anteroposterior e no centro do espaço intravertebral ou na borda superior do corpo vertebral distal na radiografia lateral. Coloque um fio guia fino através de uma agulha de punção de calibre 18 e faça uma incisão de pele de sete milímetros. Coloque cateteres de expansão de tecidos moles com diâmetros diferentes através do fio-guia e, em seguida, coloque o localizador Tom Sheety ao longo do fio-guia.Agora fixe a ponta do localizador Tom Sheety na ponta do processo articular superior apontada para o alvo da hérnia de disco e martele-o suavemente para fazê-lo passar pelo osso do processo articular. Ajuste a profundidade do localizador Tom Sheety que entra no canal vertebral de acordo com a posição da hérnia de disco. Em seguida, remova o localizador Tom Sheety, substitua o fio-guia e use brocas ósseas com diâmetros diferentes ao longo do fio-guia para triturar parte das facetas articulares para a hidroplastia intervertebral.Inserir a haste guia ao longo do fio-guia após a formação do forame intervertebral por uma broca óssea. Coloque o canal de trabalho do endoscópio ao longo da haste guia e confirme se o canal de trabalho atingiu o ponto alvo pela fluoroscopia intraoperatória novamente. Coloque um endoscópio espinhal de 7,5 milímetros de diâmetro com um canal de trabalho de 3,7 milímetros de diâmetro na hérnia de disco lombar para explorar e limpar os ligamentos e os fragmentos ósseos residuais na área do forame intervertebral, os tecidos moles no canal vertebral e o disco intervertebral lombar saliente.Remova os tecidos vermelhos moles inflamados proliferados espalhados no canal vertebral com instrumentos cirúrgicos microscópicos. Use pinça de núcleo pulposo para explorar a área rasgada da fibrose do anel e remover o tecido gravemente degenerado e inelástico. Em seguida, use pinças cirúrgicas em miniatura para remover a parte rompida da fibrose do anel e o núcleo pulposo saliente.Use radiofrequência bipolar flexível para coagular o anel fibroso e o núcleo pulposo para parar o sangramento, encolher e desnervá-los. Quando houver espaço suficiente ao redor da raiz nervosa e do saco dural durante a operação, utilizar radiofrequência bipolar flexível para realizar anuloplastia e nucleoplastia no anel fibrose residual e núcleo pulposo, respectivamente. Explore a raiz nervosa com um gancho de sonda em miniatura para garantir espaço suficiente e pulsação espontânea.Remover o endoscópio e seu canal de trabalho e suturar a pele com fio cirúrgico 4.0 não absorvente. Durante a operação, utilizar sempre o instrumento endoscópico sob irrigação contínua com soro fisiológico. Escolher medicamentos hemostáticos ou analgésicos intravenosos apropriados de acordo com a condição do paciente.Após a operação, sutura da pele e fáscia superficial na incisão do endoscópio espinhal sem a colocação de um tubo de drenagem. Injete ropivacaína ao redor da incisão para aliviar a dor e o desconforto ao redor da incisão. O reexame da RM da coluna lombar no pós-operatório mostrou que a hérnia de disco intervertebral desapareceu e a ruptura da fibrose do anel desapareceu e cicatrizou bem, formando uma zona de isolamento na face ventral da dura-máter e raiz nervosa.O passo mais importante é usar o localizador Tom Sheety e a broca óssea para que ocorra essa valiosa formação de forame. E usar orifícios endoscópicos para descompressão. Esta técnica explora a direção do tratamento endoscópico da DDD representada pela LDH e será utilizada para esta doença da coluna vertebral no futuro.

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