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J Am Acad Orthop Surg, Vol 10, No 2, March/April 2002, 80-85.
© 2002 the American Academy of Orthopaedic Surgeons
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Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation

Hallett H. Mathews, MD and Brenda H. Long, MS, RN

Dr. Mathews is Associate Clinical Professor, Department of Orthopaedic Surgery, Virginia Commonwealth University, Medical College of Virginia, Richmond, VA. Ms. Long is Clinical Researcher, MidAtlantic Spine Specialists, Richmond.

Reprint requests: Dr. Mathews, Suite 200, 7650 Parham Road, Richmond, VA 23294.

Hemilaminectomy with diskectomy, the original surgical option to address intervertebral disk herniation, was superseded by open microdiskectomy, a less invasive technique recognized as the surgical benchmark with which minimally invasive spine surgery techniques have been compared as they have been developed. These minimally invasive surgical techniques for patients with herniated nucleus pulposus and radiculopathy include laser disk decompression, arthroscopic microdiskectomy, laparoscopic techniques, foraminal endoscopy, and microendoscopic diskectomy. Each has its own complications and requires a long learning curve to develop familiarity with the technique. Patient selection, and especially disk morphology, are the most important factors in choice of technique. The optimal candidate has a previously untreated single-level herniation with limited migration or sequestration of free fragments.




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