By Alberto Alexandre, Marcos Masini, Pier Paolo Maria Menchetti

Radiologists, orthopedic and neurological surgeons current the various minimally invasive tools. Peripheral nerve difficulties and difficulties pertaining to differential analysis in designated events reminiscent of among radicular and peripheral nerve trunk lesions are mentioned, pinpointing the importance of other diagnostic instruments. Minimally invasive innovations, applied these days to reduce bone demolition, scarring and danger of recurrence are analyzed. Microdiscectomy is in comparison with the result of intradiscal suggestions, and new tools are mentioned dealing with difficulties corresponding to epidural fibrotisation, microinstability, osteoporotic or neoplastic or posttraumatic vertebral lesions.

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Adv Neurosurg. 4:81 2 17. McCulloch JA. (1989) Principles of microsurgery for lumbar disc disease. Raven Press, New York 18. Choy DS, Ascher PN, Soddekini S. et al. (1992) Percutaneous laser disc decompression. Spine. 17:949 56 19. Alexandre A, Buric J, Paradiso R. et al. (2001) Intradiscal injection of oxygen ozone for the treatment of lumbar disc herniations: result at 5 years. 12th World Congress of Neurosurgery; 284 7 20. Menchetti PPM. (2006) Percutaneous LASER disc decompression. A prospective study under C arm versus CT scan guidance.

Stereotact Funct Neurosurg; 62 (1 4): 267 272. 6. Raffaeli W. (2006) Endoscopia dello spazio epidurale. Periduros copia. In: Jankovic D, Borghi B, Rainaldi MP. Anestesia regionale. Masson. 399 403. 7. Raffaeli W, Righetti D. (2005) Surgical radio frequency epiduro scopy technique (R ResAblator) and FBSS treatment: preliminary evaluations. Acta Neurochir Suppl; 92: 121 125. , Manoel J. Teixeira, and Erich T. Fonoff Abstract Failed Back Surgery Syndrome (FBSS) is a multidimensional painful condition and its treatment remains a challenge for the surgeons.

Considerations similar to those made for migrated fragment of disc tissue are valid for extruded herniations which, however, more often need surgery since they have less tendency to disappear spontaneously and more frequently produce severe radicular pain and neurologic deficits. Also for these conditions, microdiscectomy is most often the treatment of choice. A valid alternative can be the endoscopic discectomy through a transforaminal approach. In the presence of a small fragment of tissue extruded just behind the disc, the method of CT-aided laserdiscectomy can also be carried out.

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