Abstract
Background
Discectomy of distally, inferiorly migrated disc herniations below midpedicle level of the vertebral body in the lower lumbar spine is known to be very difficult by endoscopy. The purpose of this study was to introduce the technical possibility of percutaneous endoscopic lumbar discectomy using a contralateral transforaminal approach for distally migrated disc herniation.
Methods
We reviewed 12 patients who underwent percutaneous endoscopic lumbar discectomy using the contralateral transforaminal approach for distally migrated disc herniation. Complete removal was verified through postoperative magnetic resonance imaging (MRI) follow-up in all patients. Mean follow-up was 25 months.
Results
Clinical results according to MacNab criteria were excellent in ten patients and good in two. Average visual analogue scale for lower back pain and radicular pain improved from 6.8 and 8.2 preoperatively to 1.5 and 1.4, postoperatively (p < 0.01, respectively).
Conclusion
Percutaneous endoscopic lumbar discectomy using contralateral transforaminal approach can be a useful method in patients with distally migrated disc herniation, and endoscopic navigation of anterior epidural space from the contralateral foramen in the lower lumbar spine is technically possible.
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References
Forst R, Hausmann B. Nucleoscopy—a new examination technique. Arch Orthop Trauma Surg. 1983;101:219–21.
Kambin P, Brager MD. Percutaneous posterolateral discectomy. Anatomy and mechanism. Clin Orthop. 1987;223:145–54.
Kambin P, Casey K, O’Brien E, Zhou L. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg. 1996;84:462–7.
Kambin P, O’Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop. 1998;347:150–67.
Kambin P, Zhou L. Arthroscopic discectomy of the lumbar spine. Clin Orthop. 1997;337:49–57.
Schaffer JL, Kambin P. Percutaneous posterolateral lumbar discectomy and decompression with a 6.9-millimeter cannula. Analysis of operative failures and complications. J Bone Joint Surg Am. 1991;73:822–31.
Yeung AT. Minimally invasive disc surgery with the Yeung Endoscopic Spine System (YESS). Surg Technol Int. 2000;8:267–77.
Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine. 2005;30:2570–8.
Tsou PM, Yeung AT. Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J. 2002;2:41–8.
Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27:722–31.
Ditsworth DA. Endoscopic transforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canal. Surg Neurol. 1998;49:588–98.
Eustacchio S, Flaschka G, Trummer M, Fuchs I, Unger F. Endoscopic percutaneous transforaminal treatment for herniated lumbar discs. Acta Neurochir. 2002;144:997–1004.
Mathews HH. Transforaminal endoscopic microdiscectomy. Neurosurg Clin N Am. 1996;7:59–63.
Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine. 2006;31:285–90.
Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971;53:891–903.
Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS. Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine. 2007;32:93–9.
Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop. 1989;238:9–23.
Hermantin FU, Peters T, Quartararo L, Kambin P. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am. 1999;81:958–65.
Yeung AT. The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med. 2000;67:327–32.
Cinotti G, Roysam GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation. J Bone Joint Surg Br. 1998;80:825–32.
Kotilainen E, Valtonen S. Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir. 1993;125:120–6.
Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine. 1996;21:1556–64.
Mochida J, Toh E, Nomura T, Nishimura K. The risks and benefits of percutaneous nucleotomy for lumbar disc herniation. A 10-year longitudinal study. J Bone Joint Surg Br. 2001;83:501–5.
Acknowledgment
This study was approved by the institutional review board of Kwangju Christian Hospital (KCH 2010-016), Gwangju, Korea. The authors received no funding from any commercial party related directly or indirectly to the subject of this article.
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Yeom, Ks., Choi, Ys. Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation. J Orthop Sci 16, 263–269 (2011). https://doi.org/10.1007/s00776-011-0048-0
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DOI: https://doi.org/10.1007/s00776-011-0048-0