Minimally invasive full-endoscopic spine surgery (FESS) for elderly patients
For the surgical treatment of the lumbar spinal pathology, FESS would be the minimally invasive technique (1). It can be done under local anesthesia and it requires only 8 mm skin incision. Figure 1 describes surgical scar of traditional surgery (center) and FESS (red circle). It is obvious that the scar of FESS is minimum. At the beginning, the FESS is only available for herniated nucleus pulposus. We, Tokushima University, further developed the surgical skill and nowadays the lumbar spinal canal stenosis (LSS) can be treated using FESS procedure under local anesthesia. There are three types in the LSS: i.e., foraminal, lateral recess and central stenosis. Amon them, decompression for the lateral recess (2) and central stenosis using FESS was first conducted at Tokushima University under the local anesthesia.
It is possible for super elderly patients due to local anesthesia.
Figure 2 demonstrates MRI for the lumbar spine. This patient is 90 years old male with left leg pain. The yellow circle indicates the nerve impingement area due to lateral recess stenosis. Since his cardiac and pulmonary condition is really poor, general anesthesia is not possible. FESS is performed under local anesthesia. During surgery, the decompressed nerve root is confirmed endoscopically. In Figure 3, it is obvious that the narrow foramen becomes wider after FESS. Two hours after the surgery, this patient can walk without any pain.
With usage of the FESS, fusion surgery is possible minimally invasively.
In case with slippage and scoliosis, spinal fusion is indicated. Traditionally, spinal fusion surgery required big skin incision and damage of the back muscles. In Tokushima University, lumbar spinal fusion is performed minimally invasively using FESS technique. As shown in Figure 4, with five small skin incisions, fusion surgery is possible. Through those incisions, four percutaneous pedicle screws and one percutaneous cage is inserted. So far, this technique is the least invasive fusion surgery in the world. MRI in Figure 4 reveals that decompression is obtained after surgery.
References
- Sairyo et al. J Orthop Sci. 2018 Mar;23(2):229-236.
- Sairyo et al. J Med Invest. 2017;64(1.2):1-6.
- Sairyo et al. J Med Invest. 2019;66(3.4):224-229.