• Eike Wilbers, Christian Ewelt, Stephanie Schipmann, Walter Stummer, and Mark Klingenhöfer.
• Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany.
• World Neurosurg. 2017 Sep 1; 105: 585-590.

BackgroundSufficient visualization of the operating field is crucial for success in surgery and is important especially concerning minimally invasive and deep approaches in spine surgery.MethodsThe spinal microsurgical approach was imitated using an isolated box that was accessed with different devices. Different light sources and auxiliary devices were analyzed and compared. Light sources used were a microscope, a standard operating room lamp, and a headlamp. The auxiliary devices included different tubes with and without optical light fibers, different retractors, and an endoscope.ResultsWe demonstrated that different combinations of light sources and auxiliary devices provide significantly different illumination in the artificial operating field. A tube with optical fibers seems to be superior for nonmicroscopic approaches. The smaller these tubes are in diameter, the higher the illuminance on the surgical focus.ConclusionsThe combination of tube and microscope seems to be the best choice for deep approaches in microsurgical spinal surgery. An endoscope supplies illuminance comparable to a surgical microscope.Copyright © 2017 Elsevier Inc. All rights reserved.

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