European Spine Journal

, Volume 16, Issue 3, pp 431–437 | Cite as

Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches

  • Seungcheol Lee
  • Seok-Kang Kim
  • Sang-Ho Lee
  • Won Joong Kim
  • Won-Chul Choi
  • Gun Choi
  • Song-Woo Shin
Ideas and Technical Innovations

Abstract

Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with “half-and-half” technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with “epiduroscopic” technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9–20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 ± 1.7 preoperatively to 2.6 ± 1.8 at the final follow-up (P < 0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations.

Keywords

Percutaneous endoscopic lumbar discectomy Migrated disc herniation Radiologic classification 

Notes

Acknowledgments

The authors thank Dr. Ki-Bum Park, Hye-Ran Lee, Il Lee, and Ji-Hee Hwang for the help in preparing the manuscript and figures. This work was supported by a grant from the Wooridul Spine Foundation.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Seungcheol Lee
    • 1
  • Seok-Kang Kim
    • 1
  • Sang-Ho Lee
    • 1
  • Won Joong Kim
    • 1
  • Won-Chul Choi
    • 1
  • Gun Choi
    • 1
  • Song-Woo Shin
    • 1
  1. 1.Department of NeurosurgeryWooridul Spine HospitalSeoulSouth Korea

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