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Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation

Abstract

Purpose

This study reports a new approach for percutaneous endoscopic lumbar iscectomy (PELD), especially for soft, highly down-migrated lumbar disc herniation.

Methods

Seven patients with soft, highly down-migrated lumbar disc herniation who underwent PELD via a translaminar approach under local anaesthesia from January 2013 to June 2015, including five patients who underwent failed PELD in other hospitals, were retrospectively analyzed. Clinical outcomes were evaluated according to pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and post-operative magnetic resonance imaging (MRI).

Results

The highly down-migrated lumbar disc herniation was completely removed by PELD via a translaminar approach in seven patients, as confirmed by post-operative MRI. Leg pain was eased after removal of the disc migrations. The mean follow-up duration was 9.8 (range, 6-14) months. The mean pre-operative VAS was 7.6 ± 0.8 (range, 6-9), which decreased to 3.1 ± 1.5 (range, 2-5) at one week post-operatively and to 1.3 ± 0.8 (range, 0-3) by the last follow-up visit. The mean pre-operative ODI was 61.6 (range, 46-84), which decreased to 16.3 (range, 10-28) at the one month post-operative follow-up and to 8.4 (range, 0-14) by the last follow-up visit. No recurrence was observed in any of the seven patients during the follow-up period.

Conclusion

PELD via a translaminar approach could be a good alternative option for the treatment of soft, highly down-migrated lumbar disc herniation.

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References

  1. 1.

    Andersson G (1997) Epidemiology of spinal disorders. In: Frymoyer JW, Ducker TB, Hadler NM, Kostuik JP, Weinstein JN, Whitecould TS III (eds) The adult spine: principles and practice. Raven Press, New York, NY, p 93e141

  2. 2.

    Caspar W, Iwa H (1979) A microsurgical operation for lumbar disc herniations. Neurol Surg 6:657–662

  3. 3.

    Yasargil MG (1997) Microsurgical operation for herniated disc. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O (eds) Advances in neurosurgery. Springer, Berlin, pp 81–82

  4. 4.

    Kambin P, Gellman H (1983) Percutaneous lateral discectomy of the lumbar spine: a preliminary report. Clin Ortho 174:127–132

  5. 5.

    Kambin P, Casey K, O’Brien E, Zhou L (1996) Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg 84:462–467. doi:10.3171/jns.1996.84.3.0462

  6. 6.

    Yeung AT (2000) The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med 67:327–332

  7. 7.

    Knight MT, Ellison DR, Goswami A, Hillier VF (2001) Review of safety in endoscopic laser foraminoplasty for the management of back pain. J Clin Laser Med Surg 19:147–157. doi:10.1089/10445470152927982

  8. 8.

    Mayer HM, Brock M (1993) Percutaneous endoscopic lumbar discectomy (PELD). Neurosurg Rev 16:115–120. doi:10.1007/BF00258242

  9. 9.

    Lew SM, Mehalic TF, Fagone KL (2001) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg Spine 94:216–220. doi:10.3171/spi.2001.94.2.0216

  10. 10.

    Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731. doi:10.1097/00007632-200204010-00009

  11. 11.

    Schaffer JL, Kambin P (1991) Percutaneous posterolateral lumbar discectomy and decompression with a 6.9-millimeter cannula. Analysis of operative failures and complications. J Bone Joint Surg Am 73:822–831

  12. 12.

    Lee SH, Kang BU, Ahn Y (2006) Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine 31:E285–E290, Phila 1976

  13. 13.

    Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, Shin SW (2007) Percutaneous endoscopic lumbar discectomy for migrateddisc herniation: classification of disc migration and surgical approaches. Eur Spine J 16:431–437. doi:10.1007/s00586-006-0219-4

  14. 14.

    Lew SM, Mehalic TF, Fagone KL (2001) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 94:216–220. doi:10.3171/spi.2001.94.2.0216

  15. 15.

    Jang JS, An SH, Lee SH (2006) Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech 19:338–343. doi:10.1097/01.bsd.0000204500.14719.2e

  16. 16.

    Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS (2008) Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 33:E508–E515. doi:10.1097/BRS.0b013e31817bfa1a

  17. 17.

    Schubert M, Hoogland T (2005) Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol 17:641–661. doi:10.1007/s00064-005-1156-9

  18. 18.

    Min JH, Kang SH, Lee JB, Cho TH, Suh JK, Rhyu IJ (2005) Morphometric analysis of the working zone for endoscopic lumbar discectomy. J Spinal Disord Tech 18:132–135. doi:10.1097/01.bsd.0000159034.97246.4f

  19. 19.

    Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY (2004) Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29:E326–E332. doi:10.1097/01.BRS.0000134591.32462.98

  20. 20.

    Kim JS, Choi G, Lee SH (2011) Percutaneous endoscopic lumbar discectomy via contralateral approach: a technical case report. Spine 36:E1173–E1178. doi:10.1097/BRS.0b013e3182264458

  21. 21.

    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminallumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:931–939. doi:10.1097/BRS.0b013e31816c8af7

  22. 22.

    Ruetten S, Komp M, Merk H, Godolias G (2009) Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22:122–129. doi:10.1097/BSD.0b013e318175ddb4

  23. 23.

    Kim CH, Chung CK, Jahng TA, Yang HJ, Son YJ (2012) Surgical outcome of percutaneous endoscopic interlaminar lumbar diskectomy for recurrent disk herniation after open diskectomy. J Spinal Disord Tech 25:E125–E133. doi:10.1097/BSD.0b013e31825bd111

  24. 24.

    Choi G, Prada N, Modi HN, Vasavada NB, Kim JS, Lee SH (2010) Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L4-L5 disc through an L5-S1 interlaminar approach: a technical note. Minim Invasive Neurosurg 53:147–152. doi:10.1055/s-0030-1254145

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Author information

Correspondence to Yan Wang or Xifeng Zhang.

Additional information

Jianwei Du, Xiangyu Tang and Xin Jing are co-first author.

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Du, J., Tang, X., Jing, X. et al. Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation. International Orthopaedics (SICOT) 40, 1247–1252 (2016). https://doi.org/10.1007/s00264-016-3177-4

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Keywords

  • Translaminar
  • Migrated disc herniation
  • Percutaneous endoscopic lumbar discectomy