How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

Paul R A M Depauw,Biswadjiet S Harhangi,John S Soria Van Hoeve,Pravesh S Gadjradj

doi:10.1007/s00701-018-3723-5

Paul R A M Depauw, Biswadjiet S Harhangi + Show 2 more

Open Access

https://doi.org/10.1007/s00701-018-3723-5

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Journal: Acta neurochirurgica	Publication Date: Nov 12, 2018
Citations: 13	License type: open-access

Affiliation: Erasmus MC, Leiden University Medical Center

Abstract

BackgroundPercutaneous transforaminal endoscopic discectomy (PTED) has emerged as a less invasive technique to treat symptomatic lumbar disk herniation (LDH). PTED is performed under local anesthesia with the advantage of immediate intraoperative feedback of the patient. In this paper, the technique is described as conducted in our hospital.MethodsPTED is performed under local anesthesia in prone position on thoracopelvic supports. The procedure is explained stepwise: e.g. marking, incision, introduction of the 18-gauge needle and guidewire to the superior articular process, introduction of the TomShidi needle and foraminotomy up to 9 mm, with subsequently removal of disk material through the endoscope. Scar size is around 8 mm.ConclusionPTED seems a promising alternative to conventional discectomy in patients with LDH and can be performed safely.

Highlights

Percutaneous transforaminal endoscopic discectomy (PTED) has emerged as a less invasive technique to treat symptomatic lumbar disk herniation (LDH)
Patients should understand that there is a lack of high-quality evidence on the equivalence of clinical outcomes of PTED compared to open microdiscectomy (OM)
Potential complications of PTED are except conversion to OM similar as those of OM and may include dural tear, nerve root injury, deep or superficial wound infection, progressive or persistent neurological complaints, and recurrent LDH

Summary

Limitations

As already mentioned by Kambin in 1996, proper patient selection is mandatory for a successful outcome in endoscopic disk surgery. Patients should understand that there is a lack of high-quality evidence on the equivalence of clinical outcomes of PTED compared to OM. To the best of our knowledge, PTED is expected to have similar clinical outcomes as compared to OM in the treatment of LDH [2, 6]. Potential complications of PTED are except conversion to OM similar as those of OM and may include dural tear, nerve root injury, deep or superficial wound infection, progressive or persistent neurological complaints, and recurrent LDH

Summary key points

Compliance with ethical standards