Minimally Invasive Procedures for Disorders of the Lumbar Spine

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Minimally Invasive Procedures for Disorders of the Lumbar Spine H. Gordon Deen, MD, Douglas S. Fenton, MD, Tim J. Lamer, MD Mayo Clinic Proceedings Volume 78, Issue 10, Pages 1249-1256 (October 2003) DOI: 10.4065/78.10.1249 Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Intradiskal electrothermal therapy (IDET). Left, IDET catheter navigated into optimal position covering annular tear. Right, IDET treatment in progress with thermal treatment of annular tear. Mayo Clinic Proceedings 2003 78, 1249-1256DOI: (10.4065/78.10.1249) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Kyphoplasty procedure. Left, Lateral view of lumbar compression fracture. Middle, Placement of inflatable bone tamp within the compressed vertebral body. Right, Inflation of bone tamp with height restoration of vertebral body, to be followed by injection of methylmethacrylate cement. Mayo Clinic Proceedings 2003 78, 1249-1256DOI: (10.4065/78.10.1249) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Radiofrequency neurotomy of lumbar medial branch nerves. Top, Needle electrode placement for radiofrequency neurotomy. The target is the junction of the cephalad edge of the transverse process with the superior articular process of the z joint. Bottom, Needle electrode placement. Neurotomy at the 2 sites illustrated will treat the L5-S1 z joint. o = target for radiofrequency neurotomy of the medial branch nerve. Mayo Clinic Proceedings 2003 78, 1249-1256DOI: (10.4065/78.10.1249) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Epidural injection. Left, Illustration of needle placement for transforaminal epidural injection (Needle A) and interlaminar epidural injection (Needle B). Middle, Transforaminal epidural needle placement. The needle tip is just inferior to the L4 pedicle, and contrast is seen traversing the foramen into the epidural space and outlining the L4 nerve root (arrow). Right, Interlaminar epidural needle placement. The needle enters the epidural space between the lamina, and contrast outlines the L5 nerve root. Mayo Clinic Proceedings 2003 78, 1249-1256DOI: (10.4065/78.10.1249) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions