Now a day every speciality is going for minimally invasive technique.

When we started our Neurosurgical training in 1989 the concept was adequate wide exposure of the pathology – to ensure minimal retraction of the tissue and to minimize the damage to the tissues. Now the concept is Key-Hole Surgery with the help of Neuro-endoscopic illumination and magnification. Surgeries like aqueductoplasty and third ventriculostomy were never thought of with much less morbidity. Most patients are reluctant to undergo disc surgery because of the fear of weakness, post operative pain, long immobilization etc. Now we are providing Endoscopic Treatment for Lumbar Disc Prolapse, Lumbar Canal Stenosis, Cervical Disc Prolapse, along with Neuroendoscopic treatment for pitutary tumours, hydrocephalus, intracerebral clots, etc. The endoscopic discectomy procedure used by us is that advocated by Dr. Jean Destandau M.D., an eminent Neurosurgeon from France – the pioneer of this technique – with his own designed instruments.


Standard surgical technique is the posterior approach discectomy. The use of an endoscope allows the same access port and same surgical technique to be used on vertebral canal and disc while at the same time reducing the skin incision. The advantages of this technique are the same as those for discectomy but the immediate postoperative effects are reduced allowing a more rapid rehabilitation and return to previous activities. Reduced size of incision also represents an aesthetic advantage.


Endoscopic microdiscectomy can be carried out under local, peridural or general anaesthesia. The patient is placed in the knee-chest position,withmaximum elevation of the area concerned. If necessary,the operating table can be inclined.



By means of a special localization device the point of incision and the direction of approach is determined under fluoroscopic control.


At the marked point, a 15-20 mm skin incision is made. The aponeurosis is incised using scissors. The underlying paravertebral muscles are retracted laterally and any bleeding is coagulated. A 12 mm bone chisel is inserted until contact with the posterior vertebral arc is made.


The ENDOSPINE operating tube with its obturator is pushed through the incision in the direction of the posterior arc, after which the obturator is removed. Any soft tissue that bulges into the operating cone may be removed using a rongeur.



The devise ENDOSPINE has three access ports, one for the endoscope
(4 mm. in dia), another for suction cannula (4 mm. in dia.) and the largest for surgical instruments (9 mm. in dia.) The first two are parallel and the third is at an angle of 12 degrees with the tubes converging in the plane of posterior longitudinal ligament. The angulation enables the surgeon to keep the distal ends of instruments in view at all times and to use the suction cannula as second dissecting instrument. The endospine also includes a nerve root retractor that can be used to retract the nerve root medially.


This involves resection of part of the superior lamina and part of the intervertebral articulation, with exposure of the dural sac and nerve root. Resecting the bone enables easier access to the herniated disk without any traction on the nerve root, ensuring integrity of other nerve roots that might adhere to the main root.


Resecting the bone allows access to the superior insertion of the yellow ligament. This insertion is also resected using the 90oKERRISON punch.


Once the nerve root has been accurately identified, it is dissected using a nerve retractor. The epidural veins may be coagulated if necessary with bipolar cautery. Using the integrated nerve retractor, the nerve root can be pushed medially, allowing access to the herniated disc without any danger to the neural structures. Depending on local findings, microdiscectomy involving the extraction of the easily mobilized parts of the nucleus pulposus can be carried out.


This endoscopic procedure allows adequate removal of lamina and if necessary medial part of facet, which allows good and adequate root decompression. For canal stenosis adequate decompression is possible. Migrated, extruded and herniated discs, old sclerotic discs are also comfortably excised with this procedure because of medial, lateral, cranial and caudal maneuverability of the endoscopic system. L4-5 and L5-S1 discs can be removed through a single 15-20 mm. incision because of the angulation of sacrum.



  • Minimal skin in incision
  • Internal view of operating site
  • Reduced postoperative effects-less painful for patient
  • Minimally invasive technique
  • More rapid resumption of patients previous activities
  • Patient is mobilized on the same day
  • No blood transfusion required

  • Endoscopic Spine Surgery course at Alexandria University, Egypt held on 9th -10th July 2009.
  • Faculty for 7th International Endoscopic Spine Surgery Course, held from 18th – 20th June 2009 at Bordeaux, France.
  • WENMISS (World Society for Endoscopic, Navigated, Minimally Invasive Spine Surgery) held on 21st – 23rd May 2009 with lecture on tricks & pitfalls in Endoscopic Spine Surgery held at Kotakinabalu, Malaysia from 24th May -25th May 2009 at Hospital University Sains Malaysia, Kota Bharu, Kelantan, lecture & live demonstration of Endoscopic Spine Surgery held on 26th May 2009 at Hospital Tunku Ampuan Afzan, Kuala Terengganu.
  • Course coordinator: 3rd training course of Prof. Destandau’s Technique of Endoscopic Lumbar & Cervical Discectomy at Kolhapur, Maharashtra, Indiaheld on 7th – 8th February 2009 with Dr. Destandau as course director. Covered a live demonstration of Endoscopic Lumbar & Cervical Discectomy, with hands on plastic models along with lectures.
  • Endoscopic Spine Surgery Workshop, live surgery, hands on plastic model on 24th -25th January 2009 at KIMS (Kempegauda Institute Of Medical Sciences) Bangalore, India along with lecture at BOSCON 2009,Bangalore,India organized at Orthopaedics Society’s annual conference.
  • Endoscopic Spine Surgery workshop along with live demonstration at CIIMS (Central India Institute Of Medical Sciences), Nagpur, India on 11th January 2009.
  • Performed live demonstration and hands on plastic models at 1st Egyptian Endoscopic Spine workshop of Destandau’s technique at Alexandria University & Zagazig University, held from 19th -21st August 2008.
  • 1st Saudi Spine Endoscopic Symposium & Workshop held from 10th -11th June, 2008 held at King Fahad General Hospital, Jeddah, Saudi Arabia.Collaborated with Saudi Association of Neurosurgical society for live demonstration and workshop.
  • 1st Syrian Spine Endoscopic Surgery Symposium & Workshop, 3rd – 8th June 2008, Ministry of Higher Education, University of Damascus, Faculty of Medicine, Al-Asad University Hospital, Department of Neurosurgery. Live demonstration and Workshop.
  • Cadaveric demonstration of Endoscopic Spine Surgery at WFNS (World Federation of Neurosciences) course held at Goa, India on 9th May 2008.
  • Live surgery workshop of Destandau’s technique of Endoscopic Lumbar Discectomy at Bhubaneswar, India at 1st Orissa State Symposium on Endospine. held on 16th March 2008.
  • Invited faculty at 4th International Scientific Conference & Live Neurosurgical Workshop at Dhaka, Bangladesh held from 29th February – 3rd March 2008. Live demonstration of Destandau’s technique of Endoscopic Discectomy and lecture.
  • Invited faculty at 1st International Symposium & Workshop on Micro endoscopic Discectomy & nerve root decompression held on 7th December 2007, Chandigarh, India. Gave lecture and performed live surgery along with conducting a plastic model workshop.
  • Live demonstration and lecture at Ataturk Hospital Ankara held on 7th November 2007, Turkey, on Endoscopic Spine Surgery
  • Live demonstration and lecture at 5th Feyyaz Berkay Days held at Istanbul University, Turkey on 5th November 2007.
  • Live demonstration of Endoscopic Lumbar Discectomy and Workshop at Pune, India, at 6th Armed Forces National Neurosciences Update Summit, 2007 and Annual Conference of Society for Neurosciences Pune, India (NNUD 2007) held on 3rd November 2007.
  • Live demonstration of Destandau’s technique of Lumbar Discectomy at Hazarat Rasool Akram Medical Centre, Endoscopic Surgery Training Centre, Iran University of Medical Sciences, Tehran, Iran from 11th and 12th July 2007
  • Invited faculty member at 3rd Spine Symposium held at Temple University,Philadelphia, USA on 3rd and 4th May 2007
  • Invited International Speaker at 36th annual meeting of Japanese Society of Spine Surgery & Related Research (JSRS), held in Kanazawa, Japan, on 26th & 27th April 2007
  • Organizing Secretary of 2nd Training course of Prof. Destandau’s Technique of Lumbar Endoscopic Discectomy with Dr. Destandau at Kolhapur, India on 7th-8th April 2007.
  • Invited speaker: Talk on Cervical Endoscopic Discectomy at 10th National Medical & Dental Seminar held at Mahe, Seychelles on 10th February 2007.
  • Invited faculty: Practical Courses on Neuro Endoscopy Neuro Navigation, Basic & Advanced Technique with Dr. Micheal R. Gaab as Course Directorheld from 7th – 9th December at Hannover Nordstadt Hospital,Hannover,Germany.
  • Invited faculty: Practical Course on Neuro Endoscopy & Neuro Navigation, Advanced Course for Experienced Neurosurgeons with Dr. Michael R. Gaab asCourse Director held from 30th November – 2nd December 2006, Nordstadt Hospital, Hannover, Germany
  • Live demonstration of Destandau’s Endoscopic Lumbar Discectomy , Mumbai, India at Advanced Spine Course arranged by Bombay Orthopedics Society on 18th November 2006
  • Cadaveric demonstration & lecture on Endoscopic Lumbar Discectomy at Spine 2006, Jaipur, India from 27th – 30th September 2006
  • ASSI-SSE program – Association Of Spine Surgeon’s Of India and Spine Society of Europe, 4th to 6th August 2006 Hyderabad, India. Cadaveric demonstration of Destandau’s technique, participation in debate Endo versus Microscopic technique and video presentation of PECD- Percutaneous Endoscopic Cervical Discectomy
  • Member of AAMISS, Asian Academy of Minimally Invasive Spinal Surgery
  • Live demonstration of Post Cervical Endoscopic Micro-Foraminotomy with Destandau’s technique, and paper on Percutaneous Anterior Cervical Endoscopic Discectomy technique and Lumbar Endoscopic Discectomy: Destandau’s technique, Spine Today 2006 at Coimbatore, India, 24th and 25th June 2006
  • Member Of Scientific Committee, NEUROENDOSCOPY 2007 Paris Versailles- Fourth World Conference Of The International Study Group Of Neuro Endoscopy (ISGNE) and Second World Congress of Endoscopy for Brain, Skull Base And Spine held in May 2007
  • Live demonstration of Endoscopic Lumbar Discectomy at NIMHANSBangalore, India Neurosurgery Update 2006 and Neuro Endoscopy Workshop from 15th to 17th April 2006
  • Course coordinator: 1st training course of Prof. Destandau’s Technique for Endoscopic Lumbar Discectomy on 21st & 22nd February 2006 along with Dr. Jean Destandau as Course Director held at Kolhapur, India. Live demonstration, hands-on-plastic models and video lecture.
  • Live demonstration of Destandau’s technique at 9th International Medical and Dental Seminar at Victoria Hospital Seychelles from 10th to 14th Feb.2006 at Seychelles
  • Live and video demonstration of Destandau’s technique at BOSCON 2006, (Bangalore Ortho. Society)in January 2006
  • Invited speaker at department grand round on 7th December 2005 at theCentre for Minimally Invasive Spine Surgery, The St. Luke’s Roosevelt Hospital New York (U.S.A.)
  • Workshop of Destandau’s Post Lumbar Discectomy at Istanbul, Turkey in June 2005 at 2nd Meeting of AAMISS (Asian Academy Of Minimally Invasive Spine Surgery) & 12th Meet Of IMLAS (International Musculo Skeletal Laser Society)
  • Cadaveric demonstration at Karachi, Pakistan at 3rd South Asian Neuro Surgeons Conference in March 2005
  • Live demonstration with Dr. Destandau of Lumbar & Cervical Discectomy atIndore, India, National Neurological Conference in December 2004
  • Live demonstration at Government Medical College, Solapur, India, Maharashtra Ortho Association (CME)
  • ASCICON-2004 POONA, India, Live & Cadaveric demonstration of Destandau’s technique with Dr. Martin Knight (Manchester, England), Dr. Ruven Gepstein (Israel) and Dr. Gore as co-faculty.

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