Epiduroscopic Assisted Percutaneous Endoscopic Lumbar Discectomy: A Technical Report

Gun Choi,Priyank Uniyal

doi:10.4172/2329-6895.1000306

Abstract

The Authors report a new technique with trans sacral epiduroscopy assisted Percutaneous Endoscopic Lumbar Discectomy (PELD) for high grade centrally down migrated lumbar disc herniation. When the chances of missing the disc fragments are high, as in the cases of down migrated disc herniations by conventional transforaminal PELD, it can be assisted by sacral epiduroscopy for the complete removal and confirmation of any remnant disc fragments.

Highlights

These days, all disc herniations and other pathologies in the lumbar spine can be operated by full endoscopic techniques [1,2,3,4,5,6,7,8,9,10,11,12,13,14]
Epiduroscopy was first introduced in 1931 by Burmann who examined the epidural space via endoscope [17], but it would be decades before the technology was put to use for a wider range of clinical applications including adhesiolysis and neuroplasty as popularized by Racz [18]
The flexible endoscope enables clinicians to move freely and visualise within the epidural space from the sacrum to the lumbar region. This epiduroscopy can be combined with transforaminal percutaneous endoscopic lumbar discectomy (PELD) for high grade down migrated disc herniation when the chances of missing the fragments are too high, for the complete removal under direct visualization

Summary

Introduction

These days, all disc herniations and other pathologies in the lumbar spine can be operated by full endoscopic techniques [1,2,3,4,5,6,7,8,9,10,11,12,13,14]. Access through the sacral hiatus with a flexible endoscope, has been developed to allow an alternative, longitudinal, approach to the entire lumbar epidural space [16]. The flexible endoscope enables clinicians to move freely and visualise within the epidural space from the sacrum to the lumbar region This epiduroscopy can be combined with transforaminal percutaneous endoscopic lumbar discectomy (PELD) for high grade down migrated disc herniation when the chances of missing the fragments are too high, for the complete removal under direct visualization. Epidurogram is performed which will show a flattened outline of the herniation and free flow of dye at the previous pathological level Both of the skin entry sites for sacral epiduroscopy and transforaminal PELD is closed with ethilon 3-0. A preoperative and postoperative MRI of a case is illustrated in (Figures 5 and 6)

Discussion

Conclusion