Fully Endoscopic Transforaminal Lumbar Discectomy for Upward Migration of Upper Lumbar Disc Herniation: Clinical and Radiological Outcomes and Technical Considerations.

Dong Hwa Heo,Choon Keun Park,Hyeun Sung Kim,Dong Chan Lee,Dong Keun Lee

doi:10.3390/brainsci10060363

Dong Hwa Heo, Choon Keun Park + Show 3 more

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https://doi.org/10.3390/brainsci10060363

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Journal: Brain sciences	Publication Date: Jun 10, 2020
Citations: 9	License type: CC BY 4.0

Affiliation: Leon Wiltse Memorial Hospital, Wooridul Hospital

Abstract

Microdiscectomy for the upward migration of upper lumbar herniated discs has a high risk of isthmus and facet injury. Fully endoscopic transforaminal discectomy can preserve normal bony structures during discectomy. The purpose of this study was to assess the clinical and radiological outcomes of fully endoscopic transforaminal discectomy for upward migrated upper lumbar herniated discs. All patients had upward migrated disc herniation from L1–L2 to L3–L4 levels and were treated using fully endoscopic transforaminal discectomy under local anesthesia. All enrolled patients were monitored for more than 12 months. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) of pain. Surgery-related complications were analyzed. In addition, radiological outcomes were investigated using postoperative magnetic resonance imaging (MRI) and lumbar dynamic X-ray. Twenty-eight patients were enrolled in this study. ODI and VAS significantly decreased after endoscopic transforaminal discectomy. Migrated ruptured disc particles were completely removed and confirmed on postoperative MRI in 26 of the 28 patients. Even though small remnant disc particles were detected in two patients, symptoms improved after endoscopic transforaminal discectomy. Early recurrence of herniated disc occurred at the operated segment in one patient. There were no significant complications associated with fully endoscopic transforaminal discectomy. Three patients experienced a postoperative transient tingling sensation and numbness of the leg. Fully endoscopic transforaminal lumbar discectomy may be an effective and alternative treatment option for upward migrated disc herniation in the upper lumbar area. In addition, fully endoscopic transforaminal lumbar discectomy may prevent complications associated with general endotracheal anesthesia and injuries of the isthmus and the facet joint.

Highlights

IntroductionThe upper lumbar area is characterized by an anatomically narrow spinal canal and dense rootlets compared with the lower lumbar area
Even though small remnant disc particles were detected in two patients, symptoms improved after endoscopic transforaminal discectomy
Fully endoscopic transforaminal lumbar discectomy may prevent complications associated with general endotracheal anesthesia and injuries of the isthmus and the facet joint

Summary

Introduction

The upper lumbar area is characterized by an anatomically narrow spinal canal and dense rootlets compared with the lower lumbar area. The lamina and the isthmus of the upper lumbar area are narrow compared with those in the lower lumbar area. Conventional open discectomy or microdiscectomy of upper lumbar disc herniation with upward migration is difficult and has a high risk of iatrogenic isthmic fracture, facet joint injury, and neurological damage including cauda equina injury [3]. Brain Sci. 2020, 10, 363; doi:10.3390/brainsci10060363 www.mdpi.com/journal/brainsci. Brain Sci. 2020, 10, 363 surgery could be an appropriate choice. Fusion procedures are considered in cases of upward ruptured disc or large disc herniation in the upper lumbar area due to a high risk of iatrogenic instability and neural injury [4]

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