High-Definition Imaging in Spinal Neuroendoscopy

Background: Spinal endoscopy is still under controversial discussion. An often acclaimed critic is the poor endoscopic image quality in comparison with the microscope. Since high-definition digital cameras have recently been introduced into spinal neuroendoscopy, the aim of the current study is to examine whether superior image quality has a relevant impact on intraoperativen orientation. Material and Methods: A lumbar endoscopic discectomy was recorded simultaneously in High-Definition resolution (HD) and Standard-Definition resolution (SD). 10 experienced spinal surgeons were asked to identify predefined as well as not predefined anatomic structures in HD and SD resolution. Additionally, the video quality was rated with grades from 1 ("very good") to 6 ("poor"). Results: Out of 14 predefined structures an average of 7.8 +/- 3.3 structures (55.71%) were identified in HD, 4.4 +/- 3.2 structures (31.43%) in SD (p = 0.03). Out of 14 not predefined anatomical structures, 5.9 +/- 3.6 were correctly identified in HD, 2.6 +/- 2.5 in SD (p = 0.05). Misinterpretation of structures occurred in 1.4 +/- 1 cases in HD, compared to 3 +/- 2.2 in SD (p = 0.05). Subjective impression of video quality was rated 2.2 ("good") for HD, 3.0 ("satisfactory") for SD (p = 0.03). Conclusion: HD in endoscopic discectomy accounts for a significantly more reliable identification of anatomic structures in freeze-images in comparison with standard definition images. Additionally, the subjective impression of video quality is significantly better in HD. This superior identification of structures might contribute to improve intraoperative orientation in endoscopic neurosurgery using high definition quality technology.