By Alberto Alexandre, Marcos Masini, Pier Paolo Maria Menchetti

Radiologists, orthopedic and neurological surgeons current the several minimally invasive tools. Peripheral nerve difficulties and difficulties pertaining to differential analysis in precise occasions akin to among radicular and peripheral nerve trunk lesions are mentioned, pinpointing the importance of alternative diagnostic instruments. Minimally invasive options, applied these days to lessen bone demolition, scarring and threat of recurrence are analyzed. Microdiscectomy is in comparison with the result of intradiscal options, and new tools are mentioned dealing with difficulties reminiscent of epidural fibrotisation, microinstability, osteoporotic or neoplastic or posttraumatic vertebral lesions.

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Extra info for Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves

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11. Mayer M (2006) Minimally Invasive Spine Surgery. In: Mayer M (Ed) Minimally Invasive Spine Surgery. A Surgical Manual. Germany: Springer. 12. Resnick D (2007) Evidence Based Spine Surgery. Spine 32: S15 S19. 13. Rulffes W (2006) Technological Advances of Surgical Micro scopes for Spine Surgery. In: Mayer M (Ed) Minimally Invasive Spine Surgery. A Surgical Manual. Germany: Springer. 14. Saarni S, Gylling H (2004) Evidence Based Medicine Guidelines: A Solution to Rationing or Politics Disguised as Science?

5:5 13 15. Onik G, Helmes CA. (1985) Percutaneous lumbar discectomy using a new aspiration probe. AJR Am J Roentgenol. 144:1137 40 16. Yasargil MG. (1977) Microsurgical operations for herniated lumbar disc. 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.

The activation of fibroblasts causes additional scarring and a subsequent reduction in the herniated disc tissue under strain. Around the root ganglion space, ozone improves the tissue oxygenation and through the immune modulating effect, reduces the release and activation of cytokines, bradykines and prostaglandins and other pain stimulators [1, 2, 13]. Manchikanti et al. [9] used steroids and anesthetics through epidural endoscopy with 50% of initial pain reduction but no significant residual result after 6 months.

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