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J Neurol Surg A Cent Eur Neurosurg 2018; 79(01): 019-024
DOI: 10.1055/s-0037-1599059
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Morphometric Changes of the Lumbar Intervertebral Foramen after Percutaneous Endoscopic Foraminoplasty under Local Anesthesia

Tatsuhiko Henmi
1   Department of Orthopedic Surgery, Tokushima Prefectural Naruto Hospital, Naruto, Japan
2   Department of Orthopedics, Tokushima University Graduate School of Medicine, Tokushima, Japan
,
Tomoya Terai
1   Department of Orthopedic Surgery, Tokushima Prefectural Naruto Hospital, Naruto, Japan
2   Department of Orthopedics, Tokushima University Graduate School of Medicine, Tokushima, Japan
,
Akihiro Nagamachi
2   Department of Orthopedics, Tokushima University Graduate School of Medicine, Tokushima, Japan
,
Koichi Sairyo
2   Department of Orthopedics, Tokushima University Graduate School of Medicine, Tokushima, Japan
› Author Affiliations
Further Information

Publication History

28 May 2016

24 October 2016

Publication Date:
20 March 2017 (online)

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Abstract

Background Percutaneous endoscopic diskectomy (PED) for the lumbar spine is a relatively new technique that is becoming more common due to its relatively less invasive nature. However, one possible serious complication is an exiting nerve injury when the cannula of the endoscope is inserted into the neural canal through the intervertebral foramen. A technique to enlarge the intervertebral foramen, called foraminoplasty, was recently established to insert the cannula safely into an appropriate position in the neural canal.

Methods In this study we performed foraminoplasty during PED under local anesthesia on 15 patients. Using computed tomography scans before and after surgery, the morphometric changes of the intervertebral foramen were evaluated. Surgery-related complications were reviewed.

Results There were 13 men and 2 women, 21 to 86 years of age (mean: 47.1 years). Disk levels were 13 cases at L4–L5, one case at L3–L4, and one case at L5–S1. In 50% of the cases, the mean foraminal area significantly increased from 58.6 mm2 before surgery to 88.4 mm2 after surgery (p < 0.05 by paired t test). The diameter of the foramen was increased at all three points: the lower end plate of the superior vertebrae, the disk, and the upper end plate of the inferior vertebrae. The area increased ∼ 1.5 times, especially at the upper end plate of the inferior vertebrae. In all cases, no exiting nerve injury was encountered during PED.

Conclusion Foraminoplasty was an effective method for avoiding exiting nerve root injury during transforaminal PED.

Keywords

foraminoplasty - percutaneous endoscopic diskectomy - local anesthesia - morphology
 

  • References

  • 1 Yeung AT. The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med 2000; 67 (04) 327-332
    Google Scholar
  • 2 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27 (07) 722-731
    CrossrefPubMedGoogle Scholar
  • 3 Dezawa A, Sairyo K. New minimally invasive discectomy technique through the interlaminar space using a percutaneous endoscope. Asian J Endosc Surg 2011; 4 (02) 94-98
    CrossrefPubMedGoogle Scholar
  • 4 Dezawa A, Mikami H, Sairyo K. Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine. Asian J Endosc Surg 2012; 5 (04) 200-203
    CrossrefPubMedGoogle Scholar
  • 5 Sairyo K, Egawa H, Matsuura T. , et al. State of the art: transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Invest 2014; 61 (03/04) 217-225
    CrossrefPubMedGoogle Scholar
  • 6 Choi I, Ahn JO, So WS, Lee SJ, Choi IJ, Kim H. Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety. Eur Spine J 2013; 22 (11) 2481-2487
    CrossrefPubMedGoogle Scholar
  • 7 Sairyo K, Matsuura T, Higashino K. , et al. Surgery related complications in percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Invest 2014; 61 (03/04) 264-269
    CrossrefPubMedGoogle Scholar
  • 8 Kambin P, Schaffer JL. Percutaneous lumbar discectomy. Review of 100 patients and current practice. Clin Orthop Relat Res 1989; (238) 24-34
    PubMedGoogle Scholar
  • 9 Kaneko Y, Matsumoto M, Takaishi H, Nishiwaki Y, Momoshima S, Toyama Y. Morphometric analysis of the lumbar intervertebral foramen in patients with degenerative lumbar scoliosis by multidetector-row computed tomography. Eur Spine J 2012; 21 (12) 2594-2602
    CrossrefPubMedGoogle Scholar
  • 10 Takashima H, Takebayashi T, Shishido H. , et al. Comparison with magnetic resonance three-dimensional sequence for lumbar nerve root with intervertebral foramen. Asian Spine J 2016; 10 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 11 Henmi T, Terai T, Hibino N. , et al. Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note. J Neurosurg Spine 2015; 13: 1-6
    PubMedGoogle Scholar
  • 12 Love JG. Protruded Intervertebral Disc (Fibrocartilage): (Section of Orthopaedics and Section of Neurology). Proc R Soc Med 1939; 32 (12) 1697-1721
    PubMedGoogle Scholar
  • 13 McCulloch JA, Snook D, Kruse CF. Advantages of the operating microscope in lumbar spine surgery. Instr Course Lect 2002; 51: 243-245
    PubMedGoogle Scholar
  • 14 Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg 1997; 3: 301-307
    PubMedGoogle Scholar
  • 15 Sairyo K, Sakai T, Higashino K, Inoue M, Yasui N, Dezawa A. Complications of endoscopic lumbar decompression surgery. Minim Invasive Neurosurg 2010; 53 (04) 175-178
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Mikami Y, Nagae M, Ikeda T, Tonomura H, Fujiwara H, Kubo T. Tubular surgery with the assistance of endoscopic surgery via midline approach for lumbar spinal canal stenosis: a technical note. Eur Spine J 2013; 22 (09) 2105-2112
    CrossrefPubMedGoogle Scholar
  • 17 Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years' experience. Clin Orthop Relat Res 1989; (238) 9-23
    PubMedGoogle Scholar
  • 18 Abe M, Takata Y, Higashino K. , et al. Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player. J Med Invest 2015; 62 (03/04) 238-241
    CrossrefPubMedGoogle Scholar
  • 19 Yamashita K, Higashino K, Sakai T. , et al. Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: a case report. J Med Invest 2016; 63 (1–2): 135-139
    CrossrefPubMedGoogle Scholar
  • 20 Schreiber A, Leu H. Percutaneous nucleotomy: technique with discoscopy. Orthopedics 1991; 14 (04) 439-444
    PubMedGoogle Scholar
  • 21 Ahn Y, Lee SH, Park WM, Lee HY. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 2003; 99 (3, Suppl): 320-323
    Google Scholar
  • 22 Choi G, Lee SH, Lokhande P. , et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 2008; 33 (15) E508-E515
    CrossrefPubMedGoogle Scholar
  • 23 Lee SH, Kang HS, Choi G. , et al. Foraminoplastic ventral epidural approach for removal of extruded herniated fragment at the L5-S1 level. Neurol Med Chir (Tokyo) 2010; 50 (12) 1074-1078
    CrossrefPubMedGoogle Scholar
  • 24 Ahn Y, Kim JU, Lee BH. , et al. Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy. J Neurosurg Spine 2009; 10 (06) 595-602
    CrossrefPubMedGoogle Scholar
  • 25 Choi G, Kang HY, Modi HN. , et al. Risk of developing seizure after percutaneous endoscopic lumbar discectomy. J Spinal Disord Tech 2011; 24 (02) 83-92
    CrossrefPubMedGoogle Scholar
  • 26 Silav G, Arslan M, Comert A. , et al. Relationship of dorsal root ganglion to intervertebral foramen in lumbar region: an anatomical study and review of literature. J Neurosurg Sci 2016; 60 (03) 339-344
    Google Scholar
  • 27 Hurday Y, Xu B, Guo L. , et al. Radiographic measurement for transforaminal percutaneous endoscopic approach (PELD). Eur Spine J 2016; DOI: 10.1007/s00586-016-4454-z.
    PubMedGoogle Scholar
  • 28 Yeung A, Gore S. Endoscopic foraminal decompression for failed back surgery syndrome under local anesthesia. Int J Spine Surg 2014; 8: 22 . doi: 10.14444/1022
    CrossrefPubMedGoogle Scholar
  • 29 Knight MT, Jago I, Norris C. , et al. Transforaminal endoscopic lumbar decompression & foraminoplasty: a 10 year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery. Int J Spine Surg 2014; 8 DOI: 10.14444/1021.
    PubMedGoogle Scholar