Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

Purpose. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods. In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results. Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion. The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.

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Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note

Journal of Neurosurgery Spine ◽

10.3171/2015.4.spine141305 ◽

2016 ◽

Vol 24 (2) ◽

pp. 275-280 ◽

Cited By ~ 10

Author(s):

Tatsuhiko Henmi ◽

Tomoya Terai ◽

Naohito Hibino ◽

Shinji Yoshioka ◽

Kenji Kondo ◽

...

Keyword(s):

Nucleus Pulposus ◽

Skin Incision ◽

Technical Note ◽

Leg Pain ◽

Foraminal Stenosis ◽

En Bloc ◽

Reliable Technique ◽

Transforaminal Approach ◽

Endoscopic Discectomy ◽

Endoscopic Lumbar Discectomy

Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors’ hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient’s symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.

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Radiation Exposure and Operation Time in Percutaneous Endoscopic Lumbar Discectomy Using Fluoroscopy-Based Navigation System

World Neurosurgery ◽

10.1016/j.wneu.2019.01.289 ◽

2019 ◽

Vol 127 ◽

pp. e39-e48

Author(s):

Hao Qin ◽

Shengbin Huang ◽

Lin Xu ◽

Pingou Wei ◽

Jianzhong Jiang ◽

...

Keyword(s):

Radiation Exposure ◽

Navigation System ◽

Operation Time ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Endoscopic Lumbar Discectomy

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Percutaneous Endoscopic Lumbar Discectomy Assisted by O-Arm-Based Navigation Improves the Learning Curve

BioMed Research International ◽

10.1155/2019/6509409 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Shengxiang Ao ◽

Junlong Wu ◽

Yu Tang ◽

Chao Zhang ◽

Jie Li ◽

...

Keyword(s):

Learning Curve ◽

Radiation Exposure ◽

Disc Herniation ◽

Operation Time ◽

Lumbar Discectomy ◽

Low Back ◽

Group A ◽

Group B ◽

Endoscopic Lumbar Discectomy ◽

Cannula Placement

Objective. There is a steep learning curve with traditional percutaneous endoscopic lumbar discectomy (PELD). The aim of this study is to assess the safety and efficacy of PELD assisted by O-arm-based navigation for treating lumbar disc herniation (LDH).Methods. From September of 2017 to January of 2018, 118 patients with symptomatic LDH were enrolled in the prospective cohort study. The patients undergoing PELD with O-arm-based navigation technique were defined as group A (58 cases), and those undergoing traditional X-ray fluoroscopy method were defined as group B (60 cases). We recorded the operation time, cannula placement time, radiation exposure time, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab criteria score of the 2 groups.Results. The average operation time (95.21 ± 19.05 mins) and the cannula placement time (36.38 ± 14.67 mins) in group A were significantly reduced compared with group B (operation time, 113.83 ± 22.01 mins, P<0.001; cannula placement time, 52.63 ± 17.94 mins, P<0.001). The learning curve of PELD in group A was steeper than that in group B and was lower in the relatively flat region of the end. There were significant differences of the clinical parameters at different time points (VAS of low back, P < 0.001; VAS of leg, P < 0.001; and ODI, P < 0.001). The VAS scores for low back pain and leg pain improved significantly in both groups after surgery and gradually improved as time went by. No serious complication was observed in any patients in either group.Conclusion. The study indicated that PELD assisted by O-arm navigation is safe, accurate, and efficient for the treatment of lumbar intervertebral disc herniation. It reshaped the learning curve of PELD, reduced the difficulty of surgery, and minimized radiation exposure to surgeons. This study was registered at Chinese Clinical Trail Registry (Registration Number:ChiCTR1800019586).

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Percutaneous endoscopic posterior lumbar interbody fusion(PEPLIF): technical note

10.21203/rs.3.rs-16241/v1 ◽

2020 ◽

Author(s):

Liming He ◽

Haoyu Feng ◽

Xun Ma ◽

Qiang Chang ◽

Jianjun Chang ◽

...

Keyword(s):

Interbody Fusion ◽

Lumbar Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Technical Note ◽

Lumbar Discectomy ◽

Lumbar Interbody Fusion ◽

Effective Technique ◽

Endoscopic View ◽

Transforaminal Approach ◽

Endoscopic Lumbar Discectomy

Abstract Background: Endoscopic lumbar interbody fusion is based on endoscopic lumbar discectomy, a well-established and widely used clinical procedure. Endoscopic lumbar interbody fusion has several key advantages over other types of procedures, including that it is minimally invasive, more precise, safer, and provides better visualization. Most surgeons use the transforaminal approach for this surgery. Here, we report the first percutaneous endoscopic posterior lumbar interbody fusion (PEPLIF). Methods: The authors introduce the PEPLIF technique with step by step instructions and describe key procedures in detail. Tips for controlling hemorrhages and avoiding complications during the procedure are presented. The authors also discuss the indications and advantages of applying the PEPLIF technique.Results: PEPLIF is a repeatable lumbar fusion technique.Conclusions: PEPLIF is a feasible and effective technique for the fusion of L4-5 and L5-S1 (especially L5-S1). All procedures are completed in full using endoscopy without replacing the cannula. The endoscopic view is similar to that of an open posterior lumbar interbody fusion, thus reducing the learning curve.

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