Young Il Won1, Woon Tak Yuh1, Shin Won Kwon1, Chi Heon Kim2,3, Seung Heon Yang1, Kyoung-Tae Kim4,5, Chun Kee Chung1,3,6. 1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. 2. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea chiheon1@snu.ac.kr. 3. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea. 4. Department of Neurosurgery, Kyungpook National University Hospital, South Korea. 5. Department of Neurosurgery, School of Medicine, Kyungpook National University, South Korea. 6. Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea.
Abstract
BACKGROUND: When pain caused by lumbar disc herniation (LDH) is not relieved after 4 to 6 weeks of conservative treatment, surgery is recommended. Open microdiscectomy is a standard surgical technique, but surgical endoscopy enables endoscopic lumbar surgery with clinical outcomes similar to those of standard microdiscectomy. Endoscopic lumbar discectomy is largely divided into transforaminal endoscopic lumbar discectomy (TELD) and interlaminar endoscopic lumbar discectomy (IELD). TELD was introduced about 10 years earlier than IELD and seems to be more popular than IELD. OBJECTIVE: The present article reviews the surgical technique, indications, and outcomes of IELD. Although much is still unknown, potential future perspectives are reviewed. SUMMARY: Although improved surgical techniques enable TELD to be versatile, IELD is still specifically beneficial for patients with highly migrated LDH and a high iliac crest. There is a large body of literature indicating favorable outcomes with both TELD and IELD. Currently, the selection of TELD or IELD is at the discretion of the surgeon, but the IELD surgical technique is useful for further applying endoscopic lumbar surgery for lumbar decompression or lumbar interbody fusion. The techniques can be assisted by advanced technologies such as artificial intelligence, surgical robots, and artificial reality, and a precise and systematic approach to decision-making and surgical techniques is required to combine these technologies effectively. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
BACKGROUND: When pain caused by lumbar disc herniation (LDH) is not relieved after 4 to 6 weeks of conservative treatment, surgery is recommended. Open microdiscectomy is a standard surgical technique, but surgical endoscopy enables endoscopic lumbar surgery with clinical outcomes similar to those of standard microdiscectomy. Endoscopic lumbar discectomy is largely divided into transforaminal endoscopic lumbar discectomy (TELD) and interlaminar endoscopic lumbar discectomy (IELD). TELD was introduced about 10 years earlier than IELD and seems to be more popular than IELD. OBJECTIVE: The present article reviews the surgical technique, indications, and outcomes of IELD. Although much is still unknown, potential future perspectives are reviewed. SUMMARY: Although improved surgical techniques enable TELD to be versatile, IELD is still specifically beneficial for patients with highly migrated LDH and a high iliac crest. There is a large body of literature indicating favorable outcomes with both TELD and IELD. Currently, the selection of TELD or IELD is at the discretion of the surgeon, but the IELD surgical technique is useful for further applying endoscopic lumbar surgery for lumbar decompression or lumbar interbody fusion. The techniques can be assisted by advanced technologies such as artificial intelligence, surgical robots, and artificial reality, and a precise and systematic approach to decision-making and surgical techniques is required to combine these technologies effectively. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.