Transforaminal Endoscopic Microdiscectomy
TEM – Transforaminal Endoscopic Microdiscectomy – Subproject 11
Backpain is considered to be the number one complaint of patients in Europe. 90% of all Germans suffer from backpain at least once in their life time. Vertebral disc protrusions or prolases are often the cause of such pain, causing nerve root irritation in the cervial and lumbar spine. For the afflicted patients this often means severe back pain and sometimes even substantial impairment of the patients’ range of motion. One sided overburdening can result in degenerative disc disease even in younger patients. Every year 180,000 people are afflicted in Germany alone; half of whom (up to 80,000) have to be operated on. Spinal interventions in the open high-field MRI present a new option in the treatment of these patients, concerning the minimizing of risk and maximizing therapeutic success. .
The study group Open High-Field MRI is addressing these therapeutic issues with three current research projects. Apart from diagnostics and interventional methods which have been implemented in clinical routine, special treatment methods for spinal diseases are currently being developed.
TEM is an endoscopic technique at the neuroforamen, which treats the nerve roots, the protruded disc tissue, as well as sekeletal constrictions and instabilities. The endoscopically assisted disc surgery is performed under local anesthesia. Via a dosrolateral approach, a Kirschner wire is advanced through a small incision to the afflicted disc. With this approach, the lesion of structures which might cause scarring or instabilities are avoided and the likeliness of developing a so called post-discectomy syndrome is reduced. All of these interventional steps are performed under continuous MRI monitoring. The removal of the prolapsed disc is performed though a stiff interventional instrument with an integrated endoscope and a central working channel though which various mechanical instruments, i.e. micro-tenaculi, laser-fibers, which allow the coagulation of small blood vessels can be inserted. During the procedure the high-resolution, MR-compatible endoscope allows the close inspection of the operation site.
This transforaminal, endoscopic procedure may be suited for patients with intraforaminal, extraforaminal, and lateral to mediolateral protrusions or prolapsed discs, with or without sequestration. Even medial prolapses without considerable cranial or caudal dislocation can be an indication for this procedure.
Felix Güttler
Jens Rump
Christian Seebauer
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