Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches
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.
KeywordsPercutaneous endoscopic lumbar discectomy Migrated disc herniation Radiologic classification
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.
- 3.Hijikata S, Yamagishi M, Nakayama T, et al (1975) Percutaneous nucleotomy: a new treatment method for lumbar disc herniation. J Toden Hosp 5:5–13Google Scholar
- 5.Kambin P, Gellman H (1983) Percutaneous lateral discectomy of the lumbar spine. A preliminary report. Clin Orthop 174:127–132Google Scholar
- 7.Knight MTN, Goswami AKD (2000) Endoscopic laser foraminoplasty. In: Savitz MH, Chiu JC, Yeung AT (eds) The practice of minimally invasive spinal technique, first edition. AAMISMS Education, LLC, Richmond, pp 337–340Google Scholar
- 9.McCulloch JA, Young PH (1988) Musculoskeletal and neuroanatomy of the lumbar spine. In: Essentials of spinal microsurgery. Lippincott-Raven, Philadelphia, 18:249–292Google Scholar
- 10.Onik G, Mooney V, Maroon JC, et al (1990) Automated percutaneous discectomy: a prospective multi-institutional study. Neurosurgery 26:228–232; discussion 232–233Google Scholar