Iprenburg_edit.qxp 28/9/07 05:06 Page 74
Orthopaedic Surgery Spine
Figure 1: Marking the Iliac Crest and Drawing a Line Across the Figure 6: Removing the Guidewire and the Conical Rod
Processi Spinosi
Figure 2: Administering Local Anaesthesia
Figure 7: The Image Intensifier Continuously Checks the
Position of the Working Cannula
Spine Clinic Iprenburg in Heerenveen, The Netherlands, 330 patients
Figures 3–5: Setting the Needle and Checking Its Position (3); were operated on using this procedure.
Inserting the Guidewire (4 and 5)
Most of these patients had a primary herniation and some had
345 foraminal stenosis; some of the latter group also had a foraminal
herniation. We performed retrospective research on the first 176
operated patients: 73 females and 103 males, with an average age of
45±4 years (range: 17–83). Contraindications for this procedure are
dorsally dislocated disc herniation, central stenosis and tumours.
To get a impression of the results, we compared our results after
transforaminal endoscopic surgery (TES) with results from the Swedish
National Spine Register of patients who had undergone microscopic
surgery.
19
Of course, randomised controlled trials are needed, but
these are impossible in a private facility such as the Spine Clinic
Sometimes, a big sequester can be wholly removed immediately, but Iprenburg as patients select such a facility for the specific purpose of
in most cases the ‘crabmeat’ has to be taken out with a small pair of being operated on endoscopically under local anaesthesia in day
tongs; this requires a lot of patience. Intra-operatively, the patient can surgery. Therefore, we are setting up Web-based research for all of
be asked to move his or her leg. our operated patients within the parameters of the Swedish National
Spine Register.
19
After the hernia is removed, the working cannula is also removed and
the skin is closed with an intra-cutaneously dissolving stitch. The The locations of the hernias (n=176) were as follows:
patient usually leaves the clinic two hours after the operation. Our
check-ups consist of a telephone call on the first post-operative day and • L3–L4 – 8;
another after two weeks, at which point physiotherapy is started. A • L4–L5 – 63;
final consultation takes place in the clinic after approximately six weeks. • L5–S1 – 78;
• recurrent L4–L5 – 9;
Results • recurrent L5–S1 – 6;
Between August 2004 and August 2007, in the Wilhelmina Hospital in • hernia nuclei pulposi (HNP) with foraminal stenosis – 7; and
Assen, The Netherlands and, after 1 January 2007, exclusively in the • foraminal stenosis – 5.
74 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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