Suprapedicular Circumferential Opening Technique of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for High Grade Inferiorly Migrated Lumbar Disc Herniation.

Hyeun Sung Kim,Jae Eun Park,Sol Lee,Farid Yudoyono,Sung Kyun Chung,Jeong Hoon Kim,Seong-Hoon Oh,Il-Tae Jang,Byapak Paudel,Jeong-Hoon Choi,Jee-Soo Jang,Ki Joon Kim

doi:10.1155/2018/5349680

Abstract

Purpose To evaluate the efficacy of suprapedicular circumferential opening technique (SCOT) of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) for high grade inferiorly migrated lumbar disc herniation. Material and Methods Eighteen consecutive patients who presented with back and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation were included. High grade inferiorly migrated disc was removed by the SCOT through PETLD approach. Outcome evaluation was done with visual analog scale (VAS) and Mac Nab's criteria. Result There were 14 males and 4 females. The mean age of patients was 53.3 ± 14.12 years. One, 4, and 13 patients had disc herniation at L1-2, L3-4, and L4-5 levels, respectively, on MRI, which correlated with clinical findings. The mean follow-up duration was 8.4 ± 4.31 months. According to Mac Nab's criteria, 9 patients (50%) reported excellent and the remaining 9 patients (50%) reported good outcomes. The mean preoperative and postoperative VAS for leg pain were 7.36 ± 0.73 and 1.45 ± 0.60, respectively (p < 0.001). Improvement in outcomes was maintained even at final follow-up. There was no complication. Conclusion In this preliminary study we achieved good to excellent clinical results using the SCOT of PETLD for high grade inferiorly migrated lumbar disc herniation.

Highlights

Microdiscectomy is known as a gold standard surgical procedure for lumbar disc herniation (LDH) [1,2,3,4,5,6]
Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has gained popularity to treat LDH, due to lesser injury inflicted to the posterior spinal muscle, lesser iatrogenic instability, smaller scar in the epidural space, and lesser retraction of the neural tissue
The inclusion criteria were as follows: (a) patients presented with back pain and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation, confirmed by magnetic resonance imaging (MRI) and (b) failure of conservative therapies over 4–6 weeks

Summary

Introduction

Microdiscectomy is known as a gold standard surgical procedure for lumbar disc herniation (LDH) [1,2,3,4,5,6]. Percutaneous endoscopic discectomy of the LDH has progressed considerably since introduction of the concept by Kambin in the year 1973 [1, 7,8,9,10,11]. Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has gained popularity to treat LDH, due to lesser injury inflicted to the posterior spinal muscle, lesser iatrogenic instability, smaller scar in the epidural space, and lesser retraction of the neural tissue. We applied a transforaminal suprapedicular circumferential opening technique (SCOT) for a high grade inferiorly migrated LDH.

Materials and Methods

Results

Discussion