Minimally invasive surgery (MIS) is the fastest growing field in spinal fusion surgery because it has been shown to result in fewer complications compared to open surgery in treating degenerative disc disease. As this procedure becomes more popular, there is a high clinical demand to simplify MIS techniques and to develop new instruments that can improve the efficiency of the procedure.

Interbody fusion is one of the gold standard procedures in the treatment of lumbar degenerative disc disease. It is estimated that 140,000 discectomies concomitant to interbody fusion procedures will be performed across Europe, Middle-East, and Africa in 2018, of which a growing number will be minimally invasive.

Discectomy in spinal fusion surgery typically requires the surgeon to work through a small surgical field with limited visibility. Traditionally, it requires several instruments and multiple instrument passes to make sure that the disc is cleared, and that the endplates of the vertebrae are prepped for implants. Multiple passes increase the risk of nerve root injuries.

Although surgeons assume that posterior discectomy performed with traditional tools can adequately prepare the vertebral endplates for fusion, cadaveric studies have shown that an aggressive discectomy usually removes no more than 60% of the disc material [1]. In a recent cadaver course, participants were asked to work consecutively 20 minutes on the disc removal through a tubular portal. An endoscope control was then performed for direct visualization of the endplates. To the surprise of the participants, they had to admit that the disc preparation was not as good as they had anticipated. They all agreed that complementary discectomy and endplate preparation was needed (Fig 1).

The CONCORDE Clear MIS Discectomy Device is a single-use instrument that removes the degenerated disc and prepares the endplates using readily-available standard hospital suction (Figs 2 and 3). The instrument is available in angles of 15°, 30°, and 40° and two lengths (220 mm, 270 mm) to accommodate various approaches. The diameter of the tube is 5 mm. The cutting edges shear the disc material from the endplates while the suction draws the disc material into the transparent handle, which allows surgeons to immediately see the collection of disc material. This discectomy technique requires fewer tool passes and instrument exchanges when compared to traditional techniques. The time saved from reduced instrument steps/passes may lead to reduced OR costs.

The CONCORDE Clear MIS Discectomy Device is a innovative solutions to meet the increasing demands for MIS in spine surgery.

References
1) Vialle EN, Vialle LRG, Gusmo MS. Transforaminal lumbar discectomy: quantitative study in cadavers. Coluna/Columna. 2009; 8(2):134-138.