1. Minimally Invasive Spine Surgery and Posterolateral Endoscopic Discectomy Gabriele Jasper, M.D. Anesthesiologist Interventional Pain Physician Center for Pain Control Brick, NJ Milltown, NJ

2. Common Indications- Posterolateral Endoscopic Discectomy 1.A patient with back pain and/or radicular pain who has failed conservative treatment 2. Any herniation accessible endoscopically (directly proportional to experience) 3. Patient who refuses open surgery 4. Discogenic Pain 5. Discitis

3. Contraindications - Endoscopic Spine Any pathology not accessible from the posterolateral endoscopic approach –Severe central canal stenosis Inadequate support staff or equipment to successfully perform procedure Uncooperative patient Instability

4. Surgical Approach Kambin’s Triangle Exiting Nerve Endplate Transversing Nerve Root

5. MRI with HNP and Facet Hypertrophy Neuroforaminal Stenosis T2 sagittal MRI showing HNP, left L4-L5 with compression of L5 nerve root T2 axial MRI showing HNP left L4-L5 with compression of L5 nerve root

6. The Inside Out Technique The Outside Inside Technique

7. Disc Approaches

8. The Endoscopic Approach Surgical approach The interventional pain approach The modified surgical/interventional pain approach

9. Surgical Approach

12. Interventional Pain Approach

14. Endoscopic HydroDiscectomy Instrumentation SpineJet ® EndoResector

15. Endoscopic Discectomy with Foraminotomy and Annuloplasty

19. Defect Created By the EndoResector

20. Pre-op Orders 1.Standard Pre-op Orders 2.Ancef 1gm I.V. or Gentamycin 3. All solutions that enter the disc need to have 10% antibiotic

21. Post-operative Orders 1.Follow-up one week 2. Back Brace during activity for six weeks 3.No work 1-2 weeks (depends on type of work) 4.No heavy lifting until re-evalution 5.Pain Medication

22. Questions ??

23. Thank You