Percutaneous Biportal Endoscopic Discectomy for Lumbar Disc Herniation
Percutaneous biportal endoscopic surgery was used in two channels. One portal was used for endoscopy, and the other portal was used for working channel. And, general spinal operative instruments are available during procedures. The indication of biportal endoscopic approaches is same as microdiscectomy for lumbar disc herniation. Indications of biportal endoscopic discectomy include foraminal and extraforaminal herniated disc, highly migrated disc, and cauda equina syndrome huge disc herniation like microsurgery. Operation procedures of biportal endoscopic discectomy were similar with microsurgery. The surgical anatomical view of biportal endoscopic approaches is similar to the spinal microscopic anatomy. Additional discectomy for internal decompression can be achieved like microsurgery. We suggest that percutaneous biportal endoscopic lumbar discectomy may be an effective treatment for various types of lumbar disc herniation.
KeywordsLumbar Discectomy Herniated disc Endoscopy
(1) Laminar and interlaminar space dissection; (2) right L4 laminotomy; (3) removal of ligamentum flavum; (4) decompression of lateral recess; (5) exposure of L5 nerve root right; (6) complete exposure of axillar and shoulder areas; (7) exposure of ruptured disc particle under L5 root; (8) removal of ruptured disc particles; (9) annuloplasty with radiofrequency; (10) exploration at axillar area; (11) final view
: (1) Annulotomy by RF; (2) removal of multi-fragmented disc particles; (3) additional internal decompression
(1) Laminotomy L45 left; (2) removal of ligamentum flavum; (3) removal of huge rupture disc particle without retraction; (4) removal of huge rupture particles with slight retraction; (5) complete removal of ruptured disc particles; (6) final view after full decompression
(1) Ipsilateral laminar dissection; (2) right midline laminotomy of L4; (3) midline laminotomy of L4; (4) removal of contralateral ligamentum flavum; (5) exposure of L4 exiting nerve root left; (6) removal of foraminal ligament; (7) full exposure contralateral exiting nerve root of L4; (8) removal of ruptured disc particles; (9) final endoscopic view
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