Download PDF
J Neurol Surg A Cent Eur Neurosurg 2018; 79(02): 163-168
DOI: 10.1055/s-0037-1608837
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

Transforaminal Percutaneous Endoscopic Lumbar Diskectomy for Downmigrated Disk Herniations: Lever-Up, Rotate, and Tilt Technique

Sang Soo Eun
1   Department of Orthopaedic, Spine Health Wooridul Hospital, Seoul, the Republic of Korea
,
Sang-Ho Lee
2   Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, the Republic of Korea
,
H. Yener Erken
3   Department of Orthopedic Spine Fellow, Spine Health Wooridul Hospital, Seoul, the Republic of Korea
› Author Affiliations
Further Information

Publication History

30 January 2017

28 June 2017

Publication Date:
14 December 2017 (online)

    Permissions and Reprints

Abstract

Background and Study Aims Although transforaminal percutaneous endoscopic lumbar diskectomy (PELD) offers certain advantages in the treatment of disk herniations, it used to be limited to nonmigrated or low-migrated herniations. With improvements in endoscopic spinal surgery, the range of indications for PELD has expanded. Various techniques including transforaminal and interlaminar approaches for migrated disk herniations are described in the literature. This study describes a transforaminal PELD approach to address downmigrated intracanal soft disk herniations effectively using the lever-up, rotate, and tilt technique.

Patients and Methods We performed a retrospective review of 18 patients who had been operated on with the described technique between October 2012 and December 2015. We assessed clinical outcomes using the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) preoperatively at their respective clinical visits and postoperatively at the patients' final follow-up examinations.

Results The mean preoperative VAS scores for back and leg pain were 3.75 + 1.34 (range: 2–6) and 8.3 + 0.6 (range: 8–10), respectively. The mean preoperative ODI was 67.3 + 15.3 (range: 48–90). The mean VAS scores for back and leg pain improved to 1.38 + 1.58 (range: 0–6) and 1.19 + 0.75 (range: 0–3), respectively, at the last follow-up. The mean ODI also improved to 14.1 + 6.2 (range: 8–30) at the last follow-up. All differences between the preoperative and last follow-up scores were statistically significant (p < 0.05), Two surgeries failed because of a remnant disk fragment.

Conclusions The lever-up, rotate, and tilt technique for transforaminal PELD is an effective maneuver to treat downmigrated disk herniations in selected patients by experienced surgeons.

Keywords

lever-up - rotate - tilt - PELD - endoscopic lumbar diskectomy
 

  • References

  • 1 Mohi Eldin MM, Abdel Razek NM. Epidural fibrosis after lumbar disc surgery: prevention and outcome evaluation. Asian Spine J 2015; 9 (03) 370-385
    CrossrefPubMedGoogle Scholar
  • 2 Kapetanakis S, Giovannopoulou E, Charitoudis G, Kazakos K. Transforaminal percutaneous endoscopic discectomy for lumbar disc herniation in Parkinson's disease: a case-control study. Asian Spine J 2016; 10 (04) 671-677
    CrossrefPubMedGoogle Scholar
  • 3 Shin KH, Chang HG, Rhee NK, Lim KS. Revisional percutaneous full endoscopic disc surgery for recurrent herniation of previous open lumbar discectomy. Asian Spine J 2011; 5 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 4 Kulkarni AG, Patel RS, Dutta S. Does minimally invasive spine surgery minimize surgical site infections?. Asian Spine J 2016; 10 (06) 1000-1006
    CrossrefPubMedGoogle Scholar
  • 5 Iida Y, Kataoka O, Sho T. , et al. Postoperative lumbar spinal instability occurring or progressing secondary to laminectomy. Spine 1990; 15 (11) 1186-1189
    CrossrefPubMedGoogle Scholar
  • 6 Kambin P, O'Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 1998; (347) 150-167
    PubMedGoogle Scholar
  • 7 Natarajan RN, Andersson GB, Patwardhan AG, Andriacchi TP. Study on effect of graded facetectomy on change in lumbar motion segment torsional flexibility using three-dimensional continuum contact representation for facet joints. J Biomech Eng 1999; 121 (02) 215-221
    CrossrefPubMedGoogle Scholar
  • 8 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
  • 9 Civelek E, Solmaz I, Cansever T. , et al. Radiological analysis of the triangular working zone during transforaminal endoscopic lumbar discectomy. Asian Spine J 2012; 6 (02) 98-104
    CrossrefPubMedGoogle Scholar
  • 10 Choi DJ, Choi CM, Jung JT, Lee SJ, Kim YS. Learning curve associated with complications in biportal endoscopic spinal surgery: challenges and strategies. Asian Spine J 2016; 10 (04) 624-629
    CrossrefPubMedGoogle Scholar
  • 11 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
  • 12 Lee S, Kim SK, Lee SH. , et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J 2007; 16 (03) 431-437
    CrossrefPubMedGoogle Scholar
  • 13 Choi G, Prada N, Modi HN, Vasavada NB, Kim JS, Lee SH. Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L4-L5 disc through an L5-S1 interlaminar approach: a technical note. Minim Invasive Neurosurg 2010; 53 (03) 147-152
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 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
  • 15 Lee SH, Kang BU, Ahn Y. , et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine 2006; 31 (10) E285-E290
    CrossrefPubMedGoogle Scholar
  • 16 Hijikata S, Yamagishi M, Nakayma T. Percutaneous discectomy: a new treatment method for lumbar disc herniation. J Tokyo Den-ryoku Hosp 1975; 5: 39-44
    PubMedGoogle Scholar
  • 17 Mayer HM, Brock M. Percutaneous endoscopic lumbar discectomy (PELD). Neurosurg Rev 1993; 16 (02) 115-120
    CrossrefPubMedGoogle Scholar
  • 18 Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993; 78 (02) 216-225
    CrossrefPubMedGoogle Scholar
  • 19 Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien) 1995; 133 (3-4): 107-111
    CrossrefPubMedGoogle Scholar
  • 20 Goel VK, Nishiyama K, Weinstein JN, Liu YK. Mechanical properties of lumbar spinal motion segments as affected by partial disc removal. Spine 1986; 11 (10) 1008-1012
    CrossrefPubMedGoogle Scholar
  • 21 Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine 1996; 21 (13) 1556-1563 ; discussion 1563–1564
    CrossrefPubMedGoogle Scholar
  • 22 Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 2005; 30 (22) 2570-2578
    CrossrefPubMedGoogle Scholar
  • 23 Mirkovic SR, Schwartz DG, Glazier KD. Anatomic considerations in lumbar posterolateral percutaneous procedures. Spine 1995; 20 (18) 1965-1971
    CrossrefPubMedGoogle Scholar
  • 24 Lertudomphonwanit T, Keorochana G, Kraiwattanapong C, Chanplakorn P, Leelapattana P, Wajanavisit W. Anatomic considerations of intervertebral disc perspective in lumbar posterolateral approach via Kambin's triangle: cadaveric study. Asian Spine J 2016; 10 (05) 821-827
    CrossrefPubMedGoogle Scholar
  • 25 Brock M, Patt S, Mayer HM. The form and structure of the extruded disc. Spine 1992; 17 (12) 1457-1461
    CrossrefPubMedGoogle Scholar
  • 26 Ebeling U, Reulen HJ. Are there typical localisations of lumbar disc herniations? A prospective study. Acta Neurochir (Wien) 1992; 117 (3–4): 143-148
    CrossrefPubMedGoogle Scholar
  • 27 Kuzeyli K, Cakir E, Usul H. , et al. Posterior epidural migration of lumbar disc fragments: report of three cases. Spine 2003; 28 (03) E64-E67
    PubMedGoogle Scholar
  • 28 Schellinger D, Manz HJ, Vidic B. , et al. Disk fragment migration. Radiology 1990; 175 (03) 831-836
    CrossrefPubMedGoogle Scholar
  • 29 Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 2008; 33 (09) 931-939
    CrossrefPubMedGoogle Scholar
  • 30 Ruetten S, Komp M, Godolias G. Full-endoscopic interlaminar operation of lumbar disc herniations using new endoscopes and instruments. Orthop Praxis 2005; 10: 527-532
    PubMedGoogle Scholar
  • 31 Yoshimoto M, Iesato N, Terashima Y. , et al. Long-term outcome of microendoscopic discectomy for lumbar disc herniation. A clinical study of consecutive 112 cases with more than 5-year follow-up. J Neurol Surg A 2017; 78: 446-452
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Du J, Tang X, Jing X, Li N, Wang Y, Zhang X. Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation. Int Orthop 2016; 40 (06) 1247-1252
    CrossrefPubMedGoogle Scholar