Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with "U" Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy.

Binbin Wu,Xianfa Lin,Qingquan Lian,Haibo Yan,Gonghao Zhan,Shaobo Zhang

doi:10.1155/2017/7439016

Abstract

The objective was to report a case of a 63-year-old man with a history of low back pain (LBP) and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD), which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient's symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS) recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients.

Highlights

Lumbar spinal stenosis (LSS) is the most common spinal degenerative condition and usually related to the occurrence of low back pain (LBP), functional limitations, and disability [1]
It has been demonstrated that percutaneous endoscopic lumbar discectomy (PELD) is a relatively safe, minimally invasive procedure for LSS and lumbar disc herniation (LDH) compared with Open discectomy (OD), with merits such as less tissue trauma and blood loss, shorter mean disability period, and recovery time
Despite the above advantages and inspiring clinical results, PELD is not universally adopted because of some disadvantages, such as difficulty in anatomical delineation during the endoscopic approach and the learning curve to disassociate the neural structure from the instruments or to develop skillset and experience to safely perform the surgery

Summary

Introduction

Lumbar spinal stenosis (LSS) is the most common spinal degenerative condition and usually related to the occurrence of low back pain (LBP), functional limitations, and disability [1]. The causes can be intervertebral joint hypertrophy, osteophytes, and lumbar disc herniation (LDH) [2]. Recent advancements in minimal invasive discectomy operations include the transforaminal percutaneous endoscopic lumbar discectomy (PELD) approach that has many advantages compared to older techniques in terms of protecting the lamina, muscles, ligaments, and spinal canal, as well as long-term success by minimizing postoperative. The objective of the case report was to describe the “U” route PELD technique, which could effectively treat lumbar scoliosis combined with lumbar stenosis, caused by herniation and/or osteophyte on L3-4 and L4-5 discs, with the aim of enriching the knowledge and further applications (b) of “U” route PELD

Case Presentation

Findings

Discussion