低侵襲手術の到達点—脊椎内視鏡

Attainment of the Lessinvasive Neurospinal Surgery: Full Endoscopic Spinal Surgery

Point

・全内視鏡下脊椎手術（FESS）で使用される内視鏡はforaminoscope（椎間孔鏡）であるので，椎間孔からのアクセスを習熟することが肝要である．

・水中手術であるため，われわれ脳神経外科医にとって重要な硬膜内外の圧に影響を与えながら処置を行っていることを自覚することが重要である．

・FESSは極めて低侵襲な手術手技であるが，その習熟には急峻なラーニングカーブが存在する．

　Full endoscopic spinal surgery（FESS）is the the least invasive surgery among the current spinal surgeries. FESS approach can be used to perform discectomy, decompression for stenosis, posterolateral fusion, etc. with little destruction of the spinal structure and posterior supporting elements, under local or general anesthesia. A major difference from conventional spinal surgeries is “underwater surgery,” in which surgery is performed under continuous saline irrigation. In addition, for neurosurgeons, there is a steep learning curve to becoming proficient in using a small diameter endoscope for full-endoscopic surgery as well as performing treatment with the surgical field completely. We would like to explain the indication and surgical procedure of the transforaminal approach, then introduce decompression by FESS at the cervical spine level as well as full endoscopic lateral lumbar interbody fusion（ELIF）.