Speculum lumbar extraforaminal microdiscectomy.

Background Context: Public interest, monetary pressures and improving diagnostic techniques have placed an increasing emphasis on minimalism in lumbar disc excision. Current techniques include microlumbar discectomy and minimally invasive spinal surgery. Both are good techniques but may be painful, require a hospital stay and/or are not widely used because of difficulty acquiring the necessary skills.

Laparoscopic Lumbar Discectomy.

The developing field of laparoscopic spinal surgery is indebted not only to laparoscopy but also to the fields of arthroscopy and percutaneous microdiscectomy. These fields all share a common theme: the accomplishment of ever more advanced surgical procedures via minimally invasive approaches. The recent explosive development and application of these various techniques provides ample evidence that physicians and patients alike demand and expect a more refined approach to the spine.

Laparoscopic lumbar discectomy: description of transperitoneal and retroperitoneal techniques.

Dissatisfaction with minimally invasive lumbar discectomy via the postero-lateral route led the authors to develop the laparoscopic lumbar discectomy technique. The technique has evolved to a retroperitoneal route that is easier and safer than the tranperitoneal one. The ideal treatment for lumbar disc herniation is accessing the epidural space directly for selective removal of the disc herniation rather than indirectly treating it via a transdiscal route.

Transperitoneal laparoscopic approach to lumbar discectomy.

Recognition of the benefits derived from laparoscopic cholecystectomy led to the evaluation of a laparoscopic approach to the lumbar disc space. Goals included minimizing postoperative pain and disability while still achieving adequate access to the disc space, including adequate discectomy under direct visualization. Described herein are the methods used to develop the laparoscopic exposure necessary to allow anterior resection of the lumbar disc, as well as preliminary results of the first 15 patients to undergo laparoscopic discectomy.

Outpatient laparoscopic lumbar discectomy: description of technique and review of first twenty-one cases.

Economic and clinical factors have placed an increasing emphasis on minimally invasive surgical treatment of lumbar disc herniations. Percutaneous posterolateral techniques have been used increasingly over the last seven years but have definite technical limitations related to location of the disc herniation and its size. Dissatisfaction with percutaneous posterolateral lumbar discectomy (PPLD) led the senior author to explore the possibility of an anterior approach.