Posterior percutaneous endoscopic lumbar discectomy combined with the vertical anchoring technique for lumbar disc herniation with distant upward migration

Yu Xia,Keran Wang,Qiongyue Zhang,Yu Du,Xun Zhang,Xiang Gao,Liang Chen

doi:10.1186/s13018-019-1519-9

Abstract

BackgroundPosterior percutaneous endoscopic lumbar discectomy (PELD) has become a preferred procedure for the treatment of simple lumbar disc herniation (LDH) but has rarely been reported for distant upward migration. The purpose of this research was to investigate the feasibility, safety, clinical efficacy and technical points of posterior PELD combined with the vertical anchoring technique (VAT) for the treatment of LDH with distant upward migration.MethodsThirteen patients with distant upward migrated LDH who underwent posterior PELD combined with the VAT from March 2016 to May 2018 were selected. Among these cases, the herniated disc was located at L3/4 in 2 patients, L4/5 in 9 patients and L5/S1 in 2 patients. The operative time, length of hospital stay and postoperative complications were recorded. The visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores and modified MacNab criteria were used to assess surgical efficacy.ResultsAll 13 patients underwent successful surgery. We compared the VAS, ODI and JOA scores before and after surgery. The differences were statistically significant (P < 0.05). According to the modified MacNab criteria, 10 patients were assessed as “excellent”, 2 patients were assessed as “good” and 1 patient was assessed as “fair” at the last follow-up. The rate of satisfactory outcomes was 92.3%.ConclusionPosterior PELD combined with the VAT is a safe and feasible procedure for the treatment of LDH with distant upward migration and represents a new approach for this type of surgery.

Highlights

Posterior percutaneous endoscopic lumbar discectomy (PELD) is an emerging technique for the treatment of lumbar disc herniation (LDH), which has several advantages, including minimal trauma, a short operative time and a quick postoperative recovery
PELD has become a preferred procedure for the treatment of simple LDH but has rarely been reported for distant upward migration, which is a rare type of LDH [1,2,3]
Among the 13 patients, 1 experienced sensory disturbance after surgery and 1 had cerebrospinal fluid leakage, both of whom were cured after 1 month of conservative treatment (Table 2)

Summary

Introduction

Posterior percutaneous endoscopic lumbar discectomy (PELD) is an emerging technique for the treatment of lumbar disc herniation (LDH), which has several advantages, including minimal trauma, a short operative time and a quick postoperative recovery. PELD has become a preferred procedure for the treatment of simple LDH but has rarely been reported for distant upward migration, which is a rare type of LDH [1,2,3]. Lee et al believed that the intervertebral foramen approach for PELD is not suitable for the treatment of distant upward migration and suggested using open surgery. Posterior percutaneous endoscopic lumbar discectomy (PELD) has become a preferred procedure for the treatment of simple lumbar disc herniation (LDH) but has rarely been reported for distant upward migration. The purpose of this research was to investigate the feasibility, safety, clinical efficacy and technical points of posterior PELD combined with the vertical anchoring technique (VAT) for the treatment of LDH with distant upward migration

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Conclusion