Abstract
Background
Microsurgery of foraminal and extraforaminal disc herniation at the L5-S1 level remains a challenge because of the limited access by a high iliac crest, the sacral ala, large transverse processes of L5 and hidden disc fragments lateral to the zygapophyseal joint. Our aim was to present the outcome of percutaneous endoscopic lumbar discectomy (PELD) of these lateral and far lateral disc herniations at the L5-S1 level using the newly described foraminal retreat technique in a group of patients with similar preoperative diagnostic studies.
Methods
A total of 22 patients, 13 males and 9 females, with foraminal and extraforaminal lumbar disc herniation at the L5-S1 level were treated by applying the PELD between September 2004 and April 2010. The clinical findings and MRI were the main diagnostic methods. Preoperative evaluation was performed with clinical examinations, the Visual Analog Pain Scale (VAS) and Oswestry Low Back Disability Index (ODI).
Findings
According to the Macnab criteria, overall excellent or good outcomes were obtained in 18 patients (81.8 %), fair outcomes in 3 patients (13.6 %) and a poor outcome in 1 patient (4.5 %) at the last follow-up. The mean ODI was 67.3 ± 19.4 preoperatively and 26.7 ± 23.4 postoperatively. Preoperative VAS was 88.6 ± 7.6 and 28.6 ± 22.8 at 2 days, 40.5 ± 22.8 at 3 weeks, 34.3 ± 25.1 at 6-months and 32 at the last follow-up. At follow-up, two patients (9.1 %) had recurrent disc herniations that were corrected with open surgery. At the time of surgery, 16 patients held jobs. Fifteen (15) patients (93.8 %) returned to their original jobs postoperatively; one patient could not return to his original job postoperatively because of a comorbidity.
Conclusions
Percutaneous endoscopic discectomy using the foraminal retreat technique is an effective treatment method for patients with foraminal and extraforaminal disc herniations at the L5-S1 level on appropriately selected patients.
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References
Chenelle A, Shaffrey C, Lanzino G, Jane JA (1996) Treatment of far-lateral discs by an approach lateral to the facet joint. Tech Neurosurg 2:249–253
Darden B, Wade J, Alexander R, Wood K, Rhyne A, Hicks J (1995) Far lateral disc herniations treated by microscopic fragment excision: Techniques and results. Spine 20:1500–1505
Davis GW, Onik G (1989) Clinical experience with automated percutaneous lumbar discectomy. Clin Orthop 238:98–103
Epstein N (1995) Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg 83:648–656
Epstein NE, Epstein JA, Carras R, Hyman RA (1990) Far lateral disc herniations and associated structural abnormalities. Spine 15:534–539
Garrido E, Connaughton P (1991) Unilateral facetectomy approach for lateral lumbar disc herniation. J Neurosurg 74:754–756
Hazlet JW, Kinnard D (1982) Lumbar apophyseal process excision and spinal instability. Spine 7:171–176
Hermantin F, Peters T, Quartararo L, Kambin P (1999) A prospective randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg AM 81-A(7):958–965
Jane J, Haworth C, Broaddus W, Lee J, Malik J (1990) A neurosurgical approach to far-lateral disc herniation: Technical note. J Neurosurg 72:143–144
Jang J-S, S-HA RN, Lee S-H (2006) Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech 19:338–343
Kambin P, O’Brien E, Zhou L (1998) Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop 347:150–167
Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein NJ, Fossel AH, Lew RA, Liang MH (1995) Clinical correlations of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine 15:1155–1160
Kunogi J, Hasue M (1991) Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16:1312–1320
Lejeune JP, Hladky JP, Cotten A, Vinchon M, Christiaens JL (1994) Foraminal lumbar disc herniation. Experience with 83 patients. Spine (Phila Pa 1976) 19:1905–1908
Lejeune JP, Hladky JP, Cotton A, Vinchon M, Christiaens JL (1994) Foraminal lumbar disc herniation. Spine 17:1905–1908
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
Macnab I (1971) Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg AM 53:891–903
Mayer HM, Brock M (1993) Percutaneous endoscopic discectomy: surgical Technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78:216–225
Melvill R, Baxter B (1994) The intertransverse approach to extraforaminal disc protrusion in the lumbar. Spine 19:2707–2714
Muller A, Reulen H-J (1998) A paramedian tangential approach to lumbosacral extraforaminal disc herniations. Neurosurgery 43(4):854–861
Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M (2010) Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 19:181–204
O’Brien MF, Peterson D, Crockard HA (1995) A posterolateral microsurgical approach to extreme-lateral lumbar disc herniation. J Neurosurg 83:636–640
O’Hara LJ, Marshall RW (1997) Far lateral lumbar disc herniation. J Bone Joint Surg (Br) 79:943–947
Postacchini F, Cinotti G, Gumina S (1998) Microsurgical excision of lateral lumbar disc herniation through an interlaminar approach. J Bone Joint Surg Br 80:201–207
Reulen H-J, Muller A, Ebeling U (1996) Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery 39:345–351
Reulen H, Pfaundler S, Ebeling U (1987) The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation: I-A technical note. Acta Neurochir (Wien) 84
Ruetten S, Komp M, Godolias G (2007) Use of newly developed instruments and endoscopes: fullendoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6:521–530
Savitz MH, Doughty H, Burns P (1998) Percutaneous lumbar discectomy with a working endoscope and laser assistance. Neurosurg Focus 4:e9
Takano Y, Yuasa N (2005) Endoscopic discectomy for extraforaminal lumbar disc herniation. In: Dezawa A, Chen P-Q, Chung J-Y (eds) State of the art for minimally invasive spine surgery. Springer Tokyo, pp 99–106
Yeom JS, Kim KH, Hong SW, Park KW, Chang BS, Lee CK, Buchowski JM (2008) A minimally invasive technique for L5-S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach. J Neurosurg Spine 8:193–198
Yeung A (1999) Minimally invasive disc surgery with the Yeung endoscopic spine system (YESS). Surg Tech Int 8:1–11
Yeung A, Tsou P (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731
Yeung AT (2000) The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med 67(4):327–332
Yeung AT, Yeung CA (2003) Advances in endoscopic disc and spine surgery: foraminal approach. Surg Technol Int 11:253–261
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Lübbers, T., Abuamona, R. & Elsharkawy, A.E. Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level. Acta Neurochir 154, 1789–1795 (2012). https://doi.org/10.1007/s00701-012-1432-z
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DOI: https://doi.org/10.1007/s00701-012-1432-z