Endoscopic Micro Discectomy (MED)

Endoscopic discectomy is an alternative technique to Microscopic discectomy

Endoscopic discectomy

In this technique an endoscope is used to visualize the nerve root and the prolapsed disc material. Through a small incision a working insert, containing the endoscope is introduced at the affected disc level.

HOPKINS II telescope 0 degree

The surgical field (ie. bone, nerve root and the disc material) is visualized on television screen
The working insert also contains a nerve root retractor and a channel for the micro instruments to enter and reach the disc material. The prolapsed disc materials are removed through a 8mm small channel

Disc materials removal

The whole surgical procedure is performed by the surgeon looking at the television screen. Endoscopic micro discectomy claims to have produced less muscle dissection.

Both these procedures (MLD and MED) are minimally invasive spine surgeries. The advantages of these procedures are:

• Early ambulation - patients getup and walk on the same day of the surgery.
• Less hospital stay
• Cosmetically acceptable - ideal for young patients
• Less morbidity, ie. less post operative back muscle pain.
• Handling of the neural tissues are gentle and precise due to excellent illumination and magnification.

Double hook retractor system

Innovation & advancement in lumbar discectomy technique

To improve the surgical results Dr. Parthiban has introduced a new concept in retractor system in the surgical armamentarium. Minimally invasive spine surgery is recommended for its low morbidity rate. The double hook retractor, retract lumbar paraspinal muscles against spinous process, thus obviates the limitations of single hook systems.

In Micro lumbar discectomy, an incision less than 3 cm is made between two adjacent lumbar spinous processes. Subperiosteal separation of paraspinal muscles from the spinous processes and laminae is performed. A suitable Dr.Parthiban's double hook retractor is selected and the hooks are placed over the lateral aspect of the adjacent spinous processes. The hooks avoid the interspinous ligament. A suitable flat blade is now introduced on the sides of the paraspinal muscles. The parallel bars of the retractor system is now introduced in the slots available on the blades, and are distracted over a serrated bar. This maneuver now efficiently retracts the paraspinal muscle away from the spinous processes and thus providing a rectangular surgical field exposing the adjacent laminae, interlaminar space and the medial edge of the facet joint. The interspinous ligament is not disturbed.

Dr. Parthiban's Double hook retracts Muscle against bone

Hooks on adjacent spine

In lumbar foraminotomy for excision of extreme lateral disc prolapse, a 20mm incision over the selected spinous process is made and the paraspinal muscles are separated to expose the lateral edge of pars and facets

A 55mm long / 15mm Dr.Parthiban's double hook retractor is selected and the hooks are applied over the sides of the adjacent spinous process. The paraspinal muscles is now retracted against the spinous process using the flat blade, until the lateral edge of the pars is visualized. In both these procedures the paraspinal muscles are retracted effectively against the bone (spinous process) by the Dr.Parthiban's double hooks. The blades are always even and need no replacement during the procedure. All conventional micro discectomy instruments can be used without technical difficulties.

The Dr.Parthiban's double hook retractor designed by Dr. Parthiban obviates all those problems observed with single hook systems. Since the two hooks rest on adjacent spinous process, the inter laminar space is always stable. No restriction of instruments at any stage of the surgery was observed. Soft tissue insult is very limited. The Dr.Parthiban's double hook concept can be applied to all micro lumbar retractor system.

The Dr.Parthiban's double hook retractor is a simple innovative modification that uses the bones for efficient retraction of paraspinal muscles in micro lumbar discectomy and foraminotomy, thus preserving the interspinous ligament. It obviates the limitations experienced in single hook systems.

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