1 / 31

Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D.

Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D. LA VIA ENDOSCOPICA INTRAFORAMINALE NEL TRATTAMENTO DELLE ERNIE DISCALI LOMBARI. Relatore : Luigi D’Orazio Medicina del dolore A.O. San Camillo-Forlanini. The TESSYS-Concept. Operation of lumbar disc herniations via

eldon
Télécharger la présentation

Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Rome Rehabilitation 2011 XX Congresso Nazionale S.I.C.D. LA VIA ENDOSCOPICA INTRAFORAMINALE NEL TRATTAMENTO DELLE ERNIE DISCALI LOMBARI Relatore: Luigi D’Orazio Medicina del dolore A.O. San Camillo-Forlanini

  2. The TESSYS-Concept Operation of lumbar disc herniations via lateral, transforaminal, endoscopic Approach

  3. The TESSYS-Concept Indications Radiologic confirmation of lumbar herniated discs using MRI- or CT with clinical signs of nerve root compression

  4. Foraminal Approach: Lumbar Spine Hidden Zone Adjunct to Traditional Surgery • Preferred for foraminal and extraforaminal HNP • Allow access to these pain generators: • Disc • Exiting nerve • Traversing nerve • Epidural space • Superior facet • Axilla containing the DRG • Foraminal osteophytes Visualizes the “Hidden Zone” Foraminal of MacNab

  5. The TESSYS-Concept • Transforaminal puncture of the disc space at the medial pedicular plane • Entry point at the skin about 8 to 18 cm from the midline

  6. The TESSYS-Concept The direction of the trajectory depends on the specific localization of the disc herniation

  7. The TESSYS-Concept Discography or chromography and insertion of the guide wire

  8. The TESSYS-Concept • Stab incision at the entry point on the skin and • insertion of the guiding rod (angled or straight) into the neuroforamen

  9. The TESSYS-Concept If necessary enlargement of the neuroforamen using guiding tubes and crown reamers(5, 6.5, 7.5 mm Ø) to remove parts of the facet joint

  10. The TESSYS-Concept Advancement of fenestrated working tube (outer diameter 7.5 mm) over the red guiding tube and insertion of the foraminoscope

  11. The TESSYS-Concept • Viewing angle 30° • Outer diameter: 6,3 mm • Working channel: 3,7 mm • Length: 174 oder 208 mm

  12. The TESSYS-Concept • Removal of disc material using forceps • Application of the radiofrequency probe to arrest bleeding

  13. The TESSYS-Concept Anatomic considerations Neuroforamen Pedicle Facet joints Spinous process Spinal canal Disc space Thecal sac and nerve roots

  14. The TESSYS-Concept Anatomic considerations

  15. The TESSYS-Concept Radiologic landmarks

  16. The TESSYS-Concept Patient positioning In prone or lateral position in analgo-sedation or general anesthesia

  17. The TESSYS-Concept Requirement in the OR Radiolucent table and C-arc in ap and lateral view Optimal arrangement of monitors and instruments

  18. Amount of removed disc material

  19. Wound closure in subcutaneous fashion

  20. The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

  21. The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

  22. The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosis of the spinal canal Steep iliac crest for herniation at level L5/S1

  23. The TESSYS-Concept Limitations Massive deformity Spondylolisthesis Dorsal stenosisofthe spinal canal Steepiliaccrestfor herniationatlevel L5/S1

  24. The TESSYS-Concept VANTAGGI 1)Non problemi di sanguinamento 2) Ridotte complicanze( danno nervoso,trombosi,infezioni) 3) Possibile in paz. obesi< BMI 30-40 4) Riabilitazione più rapida 5) Nessuna formazione di aderenze post-operatorie 6) Anestesia locale e sedazione 7) Non crea instabilità 8) Consente di eseguire la foraminotomia 9(Day- Surgery) 10)E' una piattaforma per futuri trattamenti chirurgici discali

  25. Incidence of Complications 3.5% Yeung AT, Tsou PM :Spine Vol 27 April 2002 Gradual decrease with avoidance experience • Dysesthesias 5%-15% (Most common, usuallytemporary, notcompletelyavoidable!) • DRG, Circulatorychanges, furcalnerves, anomalousnerves • Persistentsensory deficit 1% • Persistentmotorweakness 2% • Discitis .03% • Duraltear 1% • Thrombophlebitis .5% • Bowelinjury 1/3,000 (.003%) • Vascularinjury 0% Duraltears do notneedrepair Due to no Surgicalapproach dissection

  26. CASISTICA The TESSYS-Concept L4-L5 10 F 7 M 3 L5-S1 5 F 2 M 3 Tot 15 Lateralità Dx 8 Sn 6 Mediana 1

  27. COMPLICANZE The TESSYS-Concept • Disestesie temporanee 1 (regredite con terapia medica) • Irritazione temporanea del nervo 1 • Interventi interrotti 1 (per anomalia del nervo • Interventi convertiti con altro approccio 1 ( approccio mediano per via endoscopica L5- S1)

  28. The TESSYS-Concept Conclusion • minimal invasivity • good clinical results • low complication rate • Due to: the Tessys-method represents an : attractiveandefficienttreatmentmodalityfor median toextraforaminalpositionedlumbardisc herniationsevenatthelevel L5/S1 andreducestheindicationfor „open“ discsurgery

  29. GRAZIE

More Related