Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Foraminoplastic Superior Vertebral Notch Approach with Reamers in Percutaneous Endoscopic Lumbar Discectomy : Technical Note and Clinical Outcome in Limited Indications of Percutaneous Endoscopic Lumbar Discectomy

  • Lee, Chul-Woo (Department of Neurosurgery, St. Peter's Hospital) ;
  • Yoon, Kang-Jun (Department of Neurosurgery, St. Peter's Hospital) ;
  • Ha, Sang-Soo (Department of Neurosurgery, St. Peter's Hospital) ;
  • Kang, Joon-Ki (Department of Neurosurgery, St. Peter's Hospital)
  • Received : 2015.08.24
  • Accepted : 2016.01.16
  • Published : 2016.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

To describe the details of the foraminoplastic superior vertebral notch approach (FSVNA) with reamers in percutaneous endoscopic lumbar discectomy (PELD) and to demonstrate the clinical outcomes in limited indications of PELD. Retrospective data were collected from 64 patients who underwent PELD with FSVNA from August 2012 to April 2014. Inclusion criteria were high grade migrated disc, high canal compromised disc, and disc protrusion combined with foraminal stenosis. The clinical outcomes were assessed using by the visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. Complications related to the surgery were reviewed. The procedure used a unique approach, using the superior vertebral notch as the target and performing foraminoplasty with only reamers under C-arm control. The mean age of the 55 female and 32 male patients was 52.73 years. The mean F/U period was $12.2{\pm}4.2$ months. Preoperative VAS ($8.24{\pm}1.25$) and ODI ($67.8{\pm}15.4$) score improved significantly at the last follow-up (VAS, $1.93{\pm}1.78$; ODI, $17.14{\pm}15.7$). Based on the modified MacNab criteria, excellent or good results were obtained in 95.3% of the patients. Postoperative transient dysthesia (n=2) and reoperation (n=1) due to recurred disc were reported. PELD with FSVNA could be a good method for treating lumbar disc herniation. This procedure may offer safe and efficacious results, especially in the relatively limited indications for PELD.

Keywords

References

  1. Ahn Y, Lee SH, Lee JH, Kim JU, Liu WC : Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation : clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien) 151 : 199-206, 2009 https://doi.org/10.1007/s00701-009-0204-x
  2. Ahn Y, Oh HK, Kim H, Lee SH, Lee HN : Percutaneous endoscopic lumbar foraminotomy : an advanced surgical technique and clinical outcomes. Neurosurgery 75 : 124-133; discussion 132-133, 2014 https://doi.org/10.1227/NEU.0000000000000361
  3. Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S : The current state of endoscopic disc surgery : review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician 16 : 335-344, 2013
  4. Chae KH, Ju CI, Lee SM, Kim BW, Kim SY, Kim HS : Strategies for noncontained lumbar disc herniation by an endoscopic approach : transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction CT with discogram. J Korean Neurosurg Soc 46 : 312-316, 2009 https://doi.org/10.3340/jkns.2009.46.4.312
  5. Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, et al. : Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976) 33 : E508-E515, 2008 https://doi.org/10.1097/BRS.0b013e31817bfa1a
  6. Donceel P, Du Bois M : Fitness for work after surgery for lumbar disc herniation : a retrospective study. Eur Spine J 7 : 29-35, 1998 https://doi.org/10.1007/s005860050023
  7. Endoscopic laser foraminoplasty. Clin Privil White Pap (60) : 1-13, 2012
  8. Han IH, Choi BK, Cho WH, Nam KH : The obturator guiding technique in percutaneous endoscopic lumbar discectomy. J Korean Neurosurg Soc 51 : 182-186, 2012 https://doi.org/10.3340/jkns.2012.51.3.182
  9. Hermantin FU, Peters T, Quartararo L, Kambin P : A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 81 : 958-965, 1999 https://doi.org/10.2106/00004623-199907000-00008
  10. Kambin P, Zhou L : Arthroscopic discectomy of the lumbar spine. Clin Orthop Relat Res (337) : 49-57, 1997
  11. Knight MT, Ellison DR, Goswami A, Hillier VF : Review of safety in endoscopic laser foraminoplasty for the management of back pain. J Clin Laser Med Surg 19 : 147-157, 2001 https://doi.org/10.1089/10445470152927982
  12. Knight MT, Goswami A, Patko JT, Buxton N : Endoscopic foraminoplasty : a prospective study on 250 consecutive patients with independent evaluation. J Clin Laser Med Surg 19 : 73-81, 2001 https://doi.org/10.1089/104454701750285395
  13. Lee DY, Lee SH : Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo) 48 : 383-388; discussion 388-389, 2008 https://doi.org/10.2176/nmc.48.383
  14. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH : Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc 46 : 515-521, 2009 https://doi.org/10.3340/jkns.2009.46.6.515
  15. Lee SH, Choi KC, Baek OK, Kim HJ, Yoo SH : Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation : a technical case report. Spine (Phila Pa 1976) 39 : E473-E479. 2014 https://doi.org/10.1097/BRS.0000000000000239
  16. 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
  17. Lee SH, Chung SE, Ahn Y, Kim TH, Park JY, Shin SW : Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy : a matched cohort analysis. Mt Sinai J Med 73 : 795-801, 2006
  18. 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 (Phila Pa 1976) 31 : E285-E290, 2006 https://doi.org/10.1097/01.brs.0000216446.13205.7a
  19. Lee SH, Kang HS, Choi G, Kong BJ, Ahn Y, Kim JS, et al. : Foraminoplastic ventral epidural approach for removal of extruded herniated fragment at the L5-S1 level. Neurol Med Chir (Tokyo) 50 : 1074-1078, 2010 https://doi.org/10.2176/nmc.50.1074
  20. Ruetten S, Komp M, Merk H, Godolias G : Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 33 : 1677-1682, 2009 https://doi.org/10.1007/s00264-008-0684-y
  21. Ruetten S, Komp M, Merk H, Godolias G : Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique : a prospective, randomized, controlled study. J Neurosurg Spine 10 : 476-485, 2009 https://doi.org/10.3171/2008.7.17634
  22. Ruetten S, Komp M, Merk H, Godolias G : Use of newly developed instruments and endoscopes : full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6 : 521-530, 2007 https://doi.org/10.3171/spi.2007.6.6.2
  23. Savitz MH, Doughty H, Burns P : Percutaneous lumbar discectomy with a working endoscope and laser assistance. Neurosurg Focus 4 : e9, 1998
  24. Schubert M, Hoogland T : Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol 17 : 641-661, 2005 https://doi.org/10.1007/s00064-005-1156-9
  25. 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
  26. Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, et al. : Lumbar spine : quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 207 : 391-398, 1998 https://doi.org/10.1148/radiology.207.2.9577486
  27. Yeung AT : The evolution of percutaneous spinal endoscopy and discectomy : state of the art. Mt Sinai J Med 67 : 327-332, 2000
  28. Yeung AT, Tsou PM : Posterolateral endoscopic excision for lumbar disc herniation : surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27 : 722-731, 2002 https://doi.org/10.1097/00007632-200204010-00009
  29. Yeung AT, Yeung CA : Advances in endoscopic disc and spine surgery : foraminal approach. Surg Technol Int 11 : 255-263, 2003

Cited by

  1. Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy vol.2017, pp.None, 2017, https://doi.org/10.1155/2017/7439016
  2. Suprapedicular Circumferential Opening Technique of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for High Grade Inferiorly Migrated Lumbar Disc Herniation vol.2018, pp.None, 2016, https://doi.org/10.1155/2018/5349680
  3. Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year vol.2018, pp.None, 2016, https://doi.org/10.1155/2018/7692794
  4. Percutaneous Endoscopic Spine Surgery for Extruded Lumbar Disc Herniation vol.12, pp.None, 2018, https://doi.org/10.2174/1874325001812010482
  5. 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
  6. Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report vol.2019, pp.None, 2016, https://doi.org/10.1155/2019/6078469
  7. The Usefulness of Percutaneous Endoscopic Technique in Multifocal Lumbar Pathology vol.2019, pp.None, 2016, https://doi.org/10.1155/2019/9528102
  8. Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up vol.2019, pp.None, 2019, https://doi.org/10.1155/2019/6924941
  9. Percutaneous Stenoscopic Lumbar Decompression with Paramedian Approach for Foraminal/Extraforaminal Lesions vol.13, pp.4, 2016, https://doi.org/10.31616/asj.2018.0269
  10. Deep learning-based lumbosacral reconstruction for difficulty prediction of percutaneous endoscopic transforaminal discectomy at L5/S1 level: A retrospective cohort study vol.82, pp.None, 2016, https://doi.org/10.1016/j.ijsu.2020.08.036
  11. Revision Strategy of Symptomatic Lumbar Adjacent Segment Degeneration: Full Endoscopic Decompression versus Extended Posterior Interbody Fusion vol.142, pp.None, 2020, https://doi.org/10.1016/j.wneu.2020.06.168
  12. Technical Considerations in Endoscopic Lumbar Decompression vol.145, pp.None, 2016, https://doi.org/10.1016/j.wneu.2020.07.065
  13. Foraminoplasty at the Base of the Superior Articular Process with Bone Drilling for Far-Downward Discs in Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Study vol.14, pp.None, 2016, https://doi.org/10.2147/jpr.s339883
  14. Expanded Indications of Full Endoscopic Spine Sugery vol.6, pp.suppl1, 2016, https://doi.org/10.21182/jmisst.2021.00129