Why interlaminar?Why Destandau Techniques?

Wide decompression Bilateral paraspinal muscle exposure with  bilateral laminectomy plus facectectomy with loss of posterior stabilizing structures and more stresses with more tissue trauma

The so=called " gold standard" of treatment for symptomatic lumbar spinal stenosis is a wide decompression via a bilateral paraspinal muscle stripping exposure. Although this traditional technique allows maximal neural decompression, there is morbidity related to stripping the paraspinal muscles and resection of stabilizing interspinous/supraspinous ligaments. To avoid this alternative approaches were used such as:

1. žBilateral hemi-laminotomies 
2. žInterlaminar decompression 
3. žSpinous process osteotomies 
4. žPort-hole laminotomies 
5. žInverse laminotomies 
6. žExpansile laminotomies 
7. žRestorative laminoplasty

However the methods were frauds with other difficulties and some were another open techniques

Endoscopic Approaches:
•Transforaminal(posterolateral)
•Interlaminar(posterior)√
•Anterior(retroperitoneal)

anterior approach

transforaminal approach

interlaminar approach

Each approach has its advantages and disadvantages but the most versatile is the interlaminar approach.It is the established approach for standard conventional surgeries and able to deal with most of the spine pathologies.Transforsaminal approach claimed to be the only TRUE minimal invasive approach that follow the normal orifice which is the foramen BUT it is design only for DISC pathologies with certain criteria

Why interlaminar approach?

a)Can deal with almost all spinal pathologies

b)Anatomical landscape are similar to open traditional surgery so learning curve is less steep

c)The procedures done are established standard procedures

Why Destandau technique?

There are various type of endoscopic systems which can be grouped into the followings:

• Endoscopic using tubes surgery (metrx or pipeline or easy –go) 
• Endoscopic using  endoscope such as wolf system or karl storz(destandau endospine)
• Percutaneous surgery(PELD)

Easy-Go

Metrx tubular system

Wolff System

pipeline system

Endospine Destandau

the working part of the scope

Destandau technique using endospine is a MOBILE endoscopic system

1. Tube Surgery
2. Mobile AND stable port 
3. Incision should not be more than 25mm-endoscope become unstable 
4. Adequate perspective for decompressive surgery Camera inside(acts as eyes : no blockage of image as with microscope0

An ideal endoscopic system should have the following criteria:

1. Visual aids MUST be excellent
2. View perspective must be adequate
3. Versatile system for spectrum of pathologies
4. Minimal exposure to radiatio
5. Learning curve is not steep or difficult

The role of endoscope is to be to achieve minimal invasive procedure done effectively and safely

Through

• Enhanced vision 
• Mobile system 
• Minimal radiation
• Familiar friendly approach
• Minimal inventory and no disposal items

Endoscopic is MOBILE and It can follow what you want to see .This will helps working with instruments

Through enhanced vision ONLY necessary structures are removed leaving intact other stabilizing structures

decompressed spine

stenosed spine

compressed spine

The system only required minimal inventory

instruments used

HD camera system

Hi speed Burr

And lastly MINIMAL RADIATION exposed both to surgeons/operative staffs and patients

The Image intensifier is used only the initial part to locate the level

ADVANTAGES

We can address the damaged areas that we cannot access by direct vision. It is possible to resect the hypertrophied lig. flavum and superior facet of contralateral side. More over we can confirm the compressed nerve root directly under the hypertrophied superior facet, which is not possible by direct vision. We can keep track of anatomical position and perform the decompression procedure while observing the compressed nerve root on video monitor during endoscopic surgery

The reduced dimension of the access route minimizes muscular trauma and post-operative pain ; this considerably facilitates the rapid resumption of physical activities.

Patients appreciate the aesthetic outcome of endoscopic-guided operations.

The surgeon’s eye being practically enabled to control the complete operating field means, above all, that anatomical structures can be better identified which largely compensates for the absence of three-dimensional vision.

The endoscopic view facilitates hemostasis not only of deeply located structures but also of muscles, thus contributing to improve post-operative comfort.

In addition, the large field of vision and the good depth of focus provided by the HOPKINS® endoscope are the outstanding difference between this technique and other minimally invasive techniques, all the better because the operating field is deep. This is particularly true for foraminal and extraforaminal disc hernias, spinal canal stenosis and when treating obese patients.

Finally the reduced rate of infectious complications is a crucial advantage of this technique.