DOI QR코드

DOI QR Code

A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop

  • Chun, Eun Hee (Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University) ;
  • Park, Hahck Soo (Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University)
  • Received : 2015.11.12
  • Accepted : 2015.12.03
  • Published : 2016.01.01

Abstract

Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy.

Keywords

References

  1. Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg 1995; 83: 648-56. https://doi.org/10.3171/jns.1995.83.4.0648
  2. O'Hara LJ, Marshall RW. Far lateral lumbar disc herniation. The key to the intertransverse approach. J Bone Joint Surg Br 1997; 79: 943-7. https://doi.org/10.1302/0301-620X.79B6.7876
  3. 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 (Phila Pa 1976) 2007; 32: E93-9. https://doi.org/10.1097/01.brs.0000252093.31632.54
  4. Ohmori K, Kanamori M, Kawaguchi Y, Ishihara H, Kimura T. Clinical features of extraforaminal lumbar disc herniation based on the radiographic location of the dorsal root ganglion. Spine (Phila Pa 1976) 2001; 26: 662-6. https://doi.org/10.1097/00007632-200103150-00022
  5. Park HW, Park KS, Park MS, Kim SM, Chung SY, Lee S. The comparisons of surgical outcomes and clinical characteristics between the far lateral lumbar disc herniations and the paramedian lumbar disc herniations. Korean J Spine 2013; 10: 155-9. https://doi.org/10.14245/kjs.2013.10.3.155
  6. Yoshimoto M, Iwase T, Takebayashi T, Ida K, Yamashita T. Microendoscopic discectomy for far lateral lumbar disk herniation: less surgical invasiveness and minimum 2-year follow-up results. J Spinal Disord Tech 2014; 27: E1-7. https://doi.org/10.1097/BSD.0b013e3182886fa0
  7. Garrido E, Connaughton PN. Unilateral facetectomy approach for lateral lumbar disc herniation. J Neurosurg 1991; 74: 754-6. https://doi.org/10.3171/jns.1991.74.5.0754
  8. Kim JE, Kim KH. Piriformis syndrome after percutaneous endoscopic lumbar discectomy via the posterolateral approach. Eur Spine J 2011; 20: 1663-8. https://doi.org/10.1007/s00586-011-1764-z
  9. Kim KH. Use of lidocaine patch for percutaneous endoscopic lumbar discectomy. Korean J Pain 2011; 24: 74-80. https://doi.org/10.3344/kjp.2011.24.2.74
  10. Reulen HJ, Muller A, Ebeling U. Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery 1996; 39: 345-50. https://doi.org/10.1097/00006123-199608000-00022
  11. Choi KC, Kim JS, Ryu KS, Kang BU, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician 2013; 16: 547-56.
  12. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 2002; 27: 722-31. https://doi.org/10.1097/00007632-200204010-00009
  13. Ahn Y. Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices 2012; 9: 361-6. https://doi.org/10.1586/erd.12.23
  14. 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 (Phila Pa 1976) 2008; 33: 931-9. https://doi.org/10.1097/BRS.0b013e31816c8af7

Cited by

  1. Disc Level vol.9, pp.2, 2017, https://doi.org/10.1111/os.12325
  2. Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation vol.96, pp.29, 2017, https://doi.org/10.1097/MD.0000000000007542
  3. Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients vol.10, pp.None, 2016, https://doi.org/10.2147/jpr.s120463
  4. Application of percutaneous foraminotomy with a specially designed drill tip for foraminal stenosis patient - A case report - vol.13, pp.3, 2018, https://doi.org/10.17085/apm.2018.13.3.302
  5. Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis vol.98, pp.15, 2016, https://doi.org/10.1097/md.0000000000015169
  6. The microendoscopic approach for far lateral lumbar disc herniation: a preliminary series of 33 patients vol.34, pp.1, 2016, https://doi.org/10.1186/s41984-019-0047-6
  7. Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation Using an Endoscopic Staining: A Technical Note vol.13, pp.4, 2016, https://doi.org/10.1111/os.12907