Abstract

The therapy of degenerative diseases of the lumbar spine involves both medical and socioeconomic problems. A surgical procedure may be necessary if conservative measures have been exhausted and states of exacerbated pain or neurological deficits persist. Despite good therapeutic results with conventional operations, there may be consecutive damage due to traumatization. Thus, it is important to continuously improve these procedures. Taking existing quality standards into account, the objectives must be to minimize operation-induced traumatization and negative long-term sequelae. Current research results and technical innovations must be critically applied in order to guarantee the best-possible treatment strategies. Minimal-invasive techniques can reduce tissue damage and its consequences. Endoscopic operations under continuous fluid flow bring advantages which raise these procedures in many areas to the standard level. New optics have been developed with a wide working channel for spinal surgery which enable sufficient bone resection using burrs under visual control. These days, there are various full-endoscopic techniques available which can supplement each other: for the lumbar spine there is the posterolateral to lateral transforaminal as well as the interlaminar access; for the thoracic spine, the postererolateral transforaminal and the interlaminar access; for the cervical spine, the anterior transdiscal and the posterior access. There are specific advantages and disadvantages for all of these techniques. The transforaminal access can be preferred, since it can be performed atraumatically. Nevertheless, mobility problems may arise. Here, the interlaminar procedure can expand the spectrum and enable operation of all disc herniations and lateral spinal stenosis, and in the thoracic spine special lateral disc herniations. In the cervical spine, the dorsal access enables therapy of all lateral disc herniations and foraminal stenosis. Unlike the anterior transdiscal procedure, which is the only treatment available for medial pathologies, the disc is not damaged and mobility is expanded. Considering the indication criteria, now the combination of full-endoscopic approaches with the new developed endoscopes and instruments provides sufficient decompression under visual control of lumbar, cervical and thoracic disc herniations and spinal stenosis. The results are equal to that of conventional procedures, but with all the advantages of a truly minimally-invasive procedure. In addition due to the possibility of resect bone in a sufficient way the indication is broadened with respect to techniques for spinal canal decompression. However, total avoidance of known problems in spinal surgery can hardly be imagined. In addition, open procedures will remain as indispensable in the future as they currently are. At the moment the full-endoscopic procedures are estimated as a sufficient supplementation and alternative inside the complete spectrum of spine surgery. _