Richard Wolf continues to expand the indications for spine endoscopy with the first endoscopic system for addressing central canal spinal stenosis. Previously, the options for performing a laminotomy and decompression in cases of central spinal stenosis were through an open incision or a microdiscectomy approach.
As with other Richard Wolf spine applications, the endoscope and accompanying instruments have been designed specifically for the anatomy and pathology being addressed. The instrument set, designed with Dr. Sebastian Ruetten, features a larger diameter endoscope that allows for full size Kerrisons and high-speed burrs, while still maintaining a least invasive approach with a 10 mm working sleeve. This provides the benefits of excellent visualization (including high-definition optics, bright illumination, and an irrigated bloodless field) with a minimum amount of trauma to surrounding tissues and a minimal recovery period.
The indications for use of the Vertebris Stenosis system are the same as for other laminotomy surgeries, including neurogenic claudication and radicular symptoms. A posterior approach is used similar to the interlaminar endoscopic procedure or conventional central stenosis laminotomy surgery. If the symptoms are bilateral, a single incision can be used to decompress both sides of the canal by using an “over the top” approach to address the contralateral side.
- Using fluoroscopy, target the lateral aspect of the interlaminar window with the dilator
- Insert the dilator to the medial aspect of the facet joint and place the working sleeve
- Insert the endoscope and visualize the laminae, the medial facet, and the ligamentum flavum
- Using burrs, resect the cranial lamina and medial aspect of the descending facet
- Using burrs and Kerrisons, resect the caudal lamina and medial aspect of the ascending facet
- Resect the ligamentum flavum
- If the contralateral side of the spinal canal is to be decompressed from the same incision, undercut the spineous process to gain access to the contralateral laminae and ligamentum flavum