Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Endoscopic Transforaminal Suprapedicular Approach in High Grade Inferior Migrated Lumbar Disc Herniation

  • Kim, Hyeun-Sung (Department of Neurosurgery, Mokpo Hankook Hospital) ;
  • Ju, Chang-Il (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Kim, Seok-Won (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Kim, Jong-Gue (Department of Neurosurgery, College of Medicine, Chosun University)
  • Published : 2009.02.28
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Abstract

Objective : Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. Methods : Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. Results : The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was $9.32{\pm}0.43$ points (range, 7-10 points), whereas the mean ODI was $79.82{\pm}4.53$ points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was $1.78{\pm}0.71$ points and the mean postoperative ODI improved to $15.27{\pm}3.82$ points. Conclusion : A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.

Keywords

References

  1. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY : Percutaneous endoscopic lumbar discectomy for recurrent disc herniation : surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29 : E326-E332, 2004 https://doi.org/10.1097/01.BRS.0000134591.32462.98
  2. Andrews DW, Lavyne MH : Retrospective analysis of microsurgical and standard lumbar discectomy. Spine 15 : 329-335, 1990 https://doi.org/10.1097/00007632-199004000-00015
  3. Asch HL, Lewis PJ, Moreland DB, Egnatchik JG, Yu YJ, Clabeaux DE, et al : Prospective multiple outcomes study of outpatient lumbar microdiscectomy : should 75 to 80% success rates be the norm? J Neurosurg (1 Suppl) 96 : 34-44, 2002 https://doi.org/10.3171/spi.2002.96.1.0034
  4. BenDebba M, Augustus van Alphen H, Long DM : Association between peridural scar and activity-related pain after lumbar discectomy. Neurol Res (Suppl 1) 21 : S37-S42, 1999 https://doi.org/10.1080/01616412.1999.11741025
  5. Calisaneller T, Ozdemir O, Karadeli E, Altinors N : Six months postoperative clinical and 24 hour post-operative MRI examinations after nucleoplasty with radiofrequency energy. Acta Neurochir (Wien) 149 : 495-500; discussion 500, 2007 https://doi.org/10.1007/s00701-007-1146-9
  6. Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS : Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations : extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine 32 : E93-E99, 2007 https://doi.org/10.1097/01.brs.0000252093.31632.54
  7. Choi G, Lee SH, Raiturker PP, Lee S, Chae YS : Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery (1 Suppl) 58 : ONS59-68; discussion ONS59-68, 2006
  8. Couto JM, Castilho EA, Menezes PR : Chemonucleolysis in lumbar disc herniation : a meta-analysis. Clinics 62 : 175-180, 2007 https://doi.org/10.1590/S1807-59322007000200013
  9. Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B : A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol 15 : 185-192, 2003 https://doi.org/10.1097/00008506-200307000-00005
  10. Ditsworth DA : Endoscopic transforaminal lumbar discectomy and reconfiguration : a postero-lateral approach into the spinal canal. Surg Neurol 49 : 588-597; discussion 597-598, 1998 https://doi.org/10.1016/S0090-3019(98)00004-4
  11. Donceel P, Du Bois M : Fitness for work after lumbar disc herniation : a retrospective study. Eur Spine J 7 : 29-35, 1998 https://doi.org/10.1007/s005860050023
  12. Eustacchio S, Flaschka G, Trummer M, Fuchs I, Unger F : Endoscopic percutaneous transforaminal treatment for herniated lumbar discs. Acta Neurochir (Wien) 144 : 997-1004; discussion 1003-1004, 2002 https://doi.org/10.1007/s00701-002-1003-9
  13. Fritsch EW, Heisel J, Rupp S : The failed back surgery syndrome : Reasons, intraoperative findings and long term results : a report of 182 operative treatments. Spine 21 : 626-633, 1996 https://doi.org/10.1097/00007632-199603010-00017
  14. Gill K : Retroperitoneal bleeding after automated percutaneous lumbar discectomy-a case report. Spine 15 : 1376-1377, 1990 https://doi.org/10.1097/00007632-199012000-00029
  15. Greenbarg PE, Brown MD, Pallares VS, Tompkins JS, Mann NH : Epidural anesthesia for lumbar spine surgery. J Spinal Disord 1 : 139-143, 1988
  16. Halldin K, Zoega B, Karrholm J, Lind BI, Nyberg P : Is increased segmental motion early after lumbar discectomy related to poor clinical outcome 5 years later? Int Orthop 29 : 260-264, 2005 https://doi.org/10.1007/s00264-005-0662-6
  17. Halldin K, Zoega B, Lind B, Cederlund CG : Clinical application of a new three-dimensional radiological classification of lumbar disc herniations. Ups J Med Sci 110 : 159-165, 2005
  18. Jang JS, An SH, Lee SH : Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech 19 : 338-343, 2006 https://doi.org/10.1097/01.bsd.0000204500.14719.2e
  19. Kambin P, Cohen LF, Brooks M, Schaffer JL : Development of degenerative spondylosis of the lumbar spine after partial discectomy : Comparison of laminotomy, discectomy and posterolateral discectomy. Spine 20 : 599-607, 1995 https://doi.org/10.1097/00007632-199503010-00018
  20. Kambin P, NASS : Arthroscopic microdiscectomy. Spine J (3 Suppl) 3 : 60S-64S, 2003 https://doi.org/10.1016/S1529-9430(02)00558-2
  21. Kambin P, Savitz MH : Arthroscopic microdiscectomy : an alternative to open disc surgery. Mt Sinai J Med 67 : 283-287, 2000
  22. Knop-Jergas BM, Zucherman JF, Hsu KY, DeLong B : Anatomic position of a herniated nucleus pulposus predicts the outcome of lumbar discectomy. J Spinal Disord 9 : 246-250, 1996
  23. Kotilainen E : Long-term outcome of patients suffering from clinical instability after microsurgical treatment of lumbar disc herniation. Acta Neurochir (Wien) 140 : 120-125, 1998 https://doi.org/10.1007/s007010050072
  24. Kotilainen E, Valtonen S : Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir (Wien) 125 : 120-126, 1993 https://doi.org/10.1007/BF01401838
  25. Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, et al : Percutaneous endoscopic lumbar discectomy for migrated disc herniation : classification of disc migration and surgical approaches. Eur Spine J 16 : 431-437, 2007 https://doi.org/10.1007/s00586-006-0219-4
  26. Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, et al : Operative failure of percutaneous endoscopic lumbar discectomy : a radiologic analysis of 55 Cases. Spine 31 : E285-E290, 2006 https://doi.org/10.1097/01.brs.0000216446.13205.7a
  27. Lee SH, Seo KS, Kazala K, Kim BJ, Kim MJ : Efficacy of IDET for relief of leg pain associated with discogenic low back pain. Pain Pract 4 : 281-285, 2004 https://doi.org/10.1111/j.1533-2500.2004.04401.x
  28. Lewis PJ, Weir BK, Broad RW, Grace MG : Long-term prospective study of lumbosacral discectomy. J Neurosurg 67 : 49-53, 1987 https://doi.org/10.3171/jns.1987.67.1.0049
  29. Maroon JC, Abla A, Bost J : Association between peridural scar and persistent low back pain after lumbar discectomy. Neurol Res (Suppl 1) 21 : S43-S46, 1999 https://doi.org/10.1080/01616412.1999.11741026
  30. Mayer HM, Brock M : Percutaneous endoscopic discectomy : surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78 : 216-225, 1993 https://doi.org/10.3171/jns.1993.78.2.0216
  31. McCulloch JA : Principles of Microsurgery for Lumbar Disc Diseases. New York, NY : Raven Press; 1989
  32. McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M : Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2 : 17-22, 2005 https://doi.org/10.3171/spi.2005.2.1.0017
  33. Mekhail N, Kapural L : Intradiscal thermal annuloplasty for discogenic pain: an outcome study. Pain Pract 4 : 84-90, 2004 https://doi.org/10.1111/j.1533-2500.2004.04203.x
  34. Mochida J, Nishimura K, Nomura T, Toh E, Chiba M : . Spine 21 : 1556-1563; discussion 1563-1564, 1996 https://doi.org/10.1097/00007632-199607010-00014
  35. Mochida J, Toh E, Nomura T, Nishimura K : The risks and benefits of percutaneous nucleotomy for lumbar disc herniation. A 10-year longitudinal study. J Bone Joint Surg Br 83 : 501-505, 2001 https://doi.org/10.1302/0301-620X.83B4.11508
  36. Onik G, Mooney V, Maroon JC, Wiltse L, Helms C, Schweigel, et al : Automated percutaneous discectomy : a prospective multiinstitutional study. Neurosurgery 26 : 228-232; discussion 232-233, 1990 https://doi.org/10.1227/00006123-199002000-00007
  37. Ozer AF, Oktenoglu T, Sasani M, Bozkus H, Canbulat N, Karaarslan E, et al : Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery. Neurosurgery (1 Suppl 1) 59 : ONS126-133; discussion ONS126-133, 2006
  38. Papadopoulos EC, Girardi FP, Sama A, Pappou IP, Urban MK, Cammisa FP Jr : Lumbar microdiscectomy under epidural anesthesia : a comparison study. Spine J 6 : 561-564, 2006 https://doi.org/10.1016/j.spinee.2005.12.002
  39. Park YK, Kim JH, Chung HS : Outcome analysis of patients after ligament-sparing microdiscectomy for lumbar disc herniation. Neurosurg Focus 13 : E4, 2002
  40. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al : Association between peridural scar and recurrent radicular pain after lumbar discectomy : magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 38 : 855-861; discussion 861-863, 1996 https://doi.org/10.1227/00006123-199604000-00053
  41. 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 30 : 2570-2578, 2005 https://doi.org/10.1097/01.brs.0000186327.21435.cc
  42. Ruetten S, Meyer O, Godolias G : [Epiduroscopic diagnosis and treatment of epidural adhesions in chronic back pain syndrome of patients with previous surgical treatment : first results of 31 interventions.] Z Orthop Ihre Grenzgeb 140 : 171-175, 2002 https://doi.org/10.1055/s-2002-31536
  43. Segnarbieux F, Van de Kelft E, Candon E, Bitoun J, Frerebeau P : Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation : influence on surgical approaches. Neurosurgery 34 : 643-647; discussion 648, 1994 https://doi.org/10.1227/00006123-199404000-00011
  44. Tomecek FJ, Anthony CS, Boxell C, Warren J : Discography interpretation and techniques in the lumbar spine. Neurosurg Focus 13 : E13, 2002
  45. Tsou PM, Alan Yeung C, Yeung AT : Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain : a minimal access visualized intradiscal surgical procedure. Spine J 4 : 564-573, 2004 https://doi.org/10.1016/j.spinee.2004.01.014
  46. Tsou PM , Yeung AT : Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations : outcome and technique. Spine J 2 : 41-48, 2002
  47. Williams RW : Microlumbar discectomy. A 12-year statistical review. Spine 11 : 851-852, 1986 https://doi.org/10.1097/00007632-198610000-00023
  48. Wu X, Zhuang S, Mao Z, Chen H : Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine 31 : 2689-2694, 2006 https://doi.org/10.1097/01.brs.0000244615.43199.07
  49. Yeung AT, Tsou PM : Posterolateral endoscopic excision for lumbar disc herniation. Surgical technique, outcome, and complications in 307 consecutive cases. Spine 27 : 722-731, 2002 https://doi.org/10.1097/00007632-200204010-00009
  50. Zander T, Rohlmann A, Kl$\ddot{o}$ckner C, Bergmann G : Influence of graded facetectomy and laminectomy on spinal biomechanics. Eur Spine J 12 : 427-434, 2003 https://doi.org/10.1007/s00586-003-0540-0

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