Decompression is THE REMEDY to Compression (Wiltse approach Mini-open Discectomy) скачать в хорошем качестве

Decompression is THE REMEDY to Compression (Wiltse approach Mini-open Discectomy)

Prior to my having learned how to do endoscopic lumbar discectomy/foraminotomy last year, the version of minimally invasive lumbar decompression which I was still using was the mini-open Wiltse approach for performing laminotomy & discectomy. I hadn't abandoned doing this procedure because non-instrumented (i.e., non-fusion) lumbar decompression still makes sense as a treatment option. If the only problem is compression of the nerve root by a herniated disc, why would I do instability-provoking surgery that would eventually require me to do fusion surgery using implants? It would be more safe, more efficient, and cheaper to just decompress the nerve root, and leave the lumbar spine as mobile as possible. If the problem is compression, then the solution is naturally decompression. If nothing else but a herniated disc is causing the compression, then the logical treatment is removing that herniation (hernioplasty), or removing the majority of the nucleus pulposus material (discectomy). Sure, doing an instrumented fusion (TLIF or PLIF) would certainly decompress the nerve roots along the way -- but if there's no pre-existing instability anyway, why do a surgery that would create instability (and then have to fix said instability via fusion)?.. And why go to the length of obliterating motion in a disc level if the primary problem isn't a motion/load-bearing pathology to begin with? All that said, the natural evolution of spine decompression surgery is endsocopic spine technique -- motion is preserved as much as possible, stability is maintained by going minimally invasive, recovery is made more rapid via the use of local anesthesia technique + minimal muscle & bone disruption. But it still pays to know how to do decompression the oldschool way -- via mini-open laminotomy & discectomy/foraminotomy under direct visualization.