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Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations

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Abstract

Background

Surgical options for removing high-grade down-migrated lumbar disc herniations located medial to the pedicle include an extensive laminectomy and facetectomy. A direct percutaneous endoscopic approach through the pedicle for reaching the herniated disc without risk of iatrogenic instability is feasible.

Method

The transpedicular approach consists of creating a tunnel through the pedicle. Subsequently, access to the parapedicular epidural space is obtained, and downward migrated disc can be removed.

Conclusion

This technique allows to reach migrated herniations medially to the pedicle safely and effectively.

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Abbreviations

AP:

Anterior-posterior

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PELD:

Percutaneous endoscopic lumbar discectomy

RF:

Radiofrequency

VAS:

Visual analog scale

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Author information

Authors and Affiliations

  1. Spine Center, Department of Neurosurgery and The Catholic Central Laboratory of Surgery (CCLS), Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo Daero, Seocho-gu, Seoul, 137-701, South Korea

    Javier Quillo-Olvera, Kutbuddin Akbary & Jin-Sung Kim

Authors
  1. Javier Quillo-Olvera
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  2. Kutbuddin Akbary
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  3. Jin-Sung Kim
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Contributions

All authors have contributed to the material and preparation of this manuscript.

Corresponding author

Correspondence to Jin-Sung Kim.

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The patient has consented to submission of this “How I Do It” to this journal.

Conflict of interest

The authors declare that they have no conflict of interest. This manuscript has not been submitted elsewhere.

Additional information

This article is part of the Topical Collection on Spine-Other

Electronic supplementary material

Video 1

We present the step by step of percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations. A real clinical case used to exemplify the technique, and detailed information about the procedure is shown in the video. (MOV 177781 kb)

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Quillo-Olvera, J., Akbary, K. & Kim, JS. Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations. Acta Neurochir 160, 1603–1607 (2018). https://doi.org/10.1007/s00701-018-3586-9

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  • DOI: https://doi.org/10.1007/s00701-018-3586-9

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