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

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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Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

BioMed Research International ◽

10.1155/2018/4749560 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Suxi Gu ◽

Kedong Hou ◽

Wei Jian ◽

Jianwei Du ◽

Songhua Xiao ◽

...

Keyword(s):

Radiation Exposure ◽

Operation Time ◽

Skin Incision ◽

Technical Note ◽

Lumbar Discectomy ◽

New Technique ◽

Foraminal Stenosis ◽

Transforaminal Approach ◽

A New Technique ◽

Endoscopic Lumbar Discectomy

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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A Rare Case of Progressive Palsy of the Lower Leg during Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach

Case Reports in Orthopedics ◽

10.1155/2018/7803529 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Hiroaki Manabe ◽

Kosaku Higashino ◽

Kosuke Sugiura

Keyword(s):

Disc Herniation ◽

Open Surgery ◽

Lumbar Disc ◽

Leg Pain ◽

Conversion To Open Surgery ◽

Transforaminal Approach ◽

Endoscopic Discectomy ◽

Endoscopic Lumbar Discectomy ◽

Conventional Open Surgery ◽

Spinal Muscles

Percutaneous endoscopic discectomy (PED) for lumbar disc herniation is gaining popularity with the transforaminal (TF) approach preferred because it allows surgery under local anesthesia and preserves the spinal muscles. Although this procedure has some characteristic complications, it is rare for PED to be converted to conventional open surgery due to worsening of symptoms intraoperatively. Here, we report PED via the TF approach that required conversion to open surgery. A 20-year-old man with a large disc herniation at L3/4 developed severe progressive leg pain and muscle weakness of the left leg intraoperatively. Magnetic resonance imaging revealed that the size of the herniation was unchanged and the endoscope did not reach the herniated mass. We converted to open surgery, and the patient’s postoperative course was favorable. We discuss the reasons for failure of the approach and suggest planning for an appropriate foraminoplasty to avoid the potential need for conversion to open surgery.

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Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1712463 ◽

2020 ◽

Author(s):

Kosuke Sugiura ◽

Kazuta Yamashita ◽

Hiroaki Manabe ◽

Yoshihiro Ishihama ◽

Fumitake Tezuka ◽

...

Keyword(s):

Return To Work ◽

Local Anesthesia ◽

Skin Incision ◽

Leg Pain ◽

Lateral Recess ◽

Canal Stenosis ◽

Transforaminal Approach ◽

Lateral Recess Stenosis ◽

Lumbar Spinal ◽

Herniated Nucleus Pulposus

AbstractTransforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.

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A RARE CASE OF A DISCAL CYST FOLLOWING PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY VIAA TRANSFORAMINALAPPROACH

10.36106/ijsr/4703707 ◽

2021 ◽

pp. 23-24

Author(s):

Srinu Gugulothu ◽

Bhaskar Jana ◽

Sudheer Suggala

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Cystic Lesion ◽

Low Back ◽

Transforaminal Approach ◽

Endoscopic Discectomy ◽

Rare Lesion ◽

Magnetic Resonance Imaging Mri ◽

Endoscopic Lumbar Discectomy ◽

Disc Level

Adiscal cyst is a rare lesion that causes low back pain and radiculopathy of the lower extremities. There are several reports of discal cysts occurring after surgery, but data are limited on their occurrence after percutaneous endoscopic discectomy (PED). A21-year-old man with disc herniation at the L4-L5 disc level underwent PED via a transforaminal approach. The immediate postoperative course was uneventful and his symptoms were relieved. Six weeks after surgery, low back pain and mild pain in the left thigh recurred. Magnetic resonance imaging (MRI) revealed a cystic lesion adjacent to the left side of the L4-L5 intervertebral disc. Conservative treatment was ineffective, so we reoperated using PED with the same approach. Pain improved and MRI revealed disappearance of the cystic lesion. When symptoms relapse after PED, it is necessary to consider the occurrence of a cyst. Endoscopic Minimally Invasive Surgery

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Percutaneous Full Endoscopic Posterior Decompression for Revision of Lumbar Spinal Dynamic Stabilization

10.21203/rs.3.rs-795033/v1 ◽

2021 ◽

Author(s):

Changkun Zheng ◽

Zhong Liao ◽

Weiliang cui

Keyword(s):

Disc Herniation ◽

Outcome Data ◽

Dynamic Stabilization ◽

Endoscopic Approach ◽

Leg Pain ◽

Foraminal Stenosis ◽

Posterior Decompression ◽

Endoscopic Discectomy ◽

Poor Outcomes ◽

Lumbar Spinal

Abstract Objective: The objective of this article was to analysis the efficacy of percutaneous full endoscopic posterior decompression for revision of lumbar spinal dynamic stabilization.Methods: Twenty consecutive patients with failed lumbar spinal dynamic stabilization presenting with leg pain that had supporting imaging diagnosis of lateral stenosis and /or residual / recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal dynamic stabilization surgery for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen for foraminal stenosis, or foraminoplasty to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow up time was, average 37.9 months, minimum 24 months. Outcome data at each visit included Macnab, VAS and ODI.Results: The average leg Visual Analog Scale improved from 8.9 ± 2.6 to 1.08± 0.7 (p < 0.005). Fifteen patients had excellent outcomes, four had good outcomes, one had fair outcomes, and no had poor outcomes, according to the Macnab criteria (Table 2). Nineteen of 20 patients had excellent or good outcomes, for an overall success rate of 95%. No patients required reoperation. There were no incidental durotomies, infections, vascular or visceral injuries. They were also relieved to be able to avoid "open" decompression.Conclusion: The transforaminal endoscopic approach is effective for failed lumbar spinal dynamic stabilization surgery due to residual/recurrent nucleus pulposus and lateral stenosis. Failed initial index surgery may involve failure to recognize patho-anatomy in the axilla of the foramen housing the traversing and the exiting nerve. The transforaminal endoscopic approach effectively decompresses the foramen and does not further destabilize the spine needing stabilization. It also avoids going through the previous surgical site.

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Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1–2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases

Journal of Neurosurgery Spine ◽

10.3171/2017.11.spine17509 ◽

2018 ◽

Vol 29 (1) ◽

pp. 46-53 ◽

Cited By ~ 5

Author(s):

Adetokunbo A. Oyelese ◽

Jared Fridley ◽

David B. Choi ◽

Albert Telfeian ◽

Ziya L. Gokaslan

Keyword(s):

Lumbar Disc ◽

Technical Note ◽

Neurological Injury ◽

Ct Guided ◽

Intraoperative Ct ◽

Transforaminal Approach ◽

Endoscopic Discectomy ◽

Disc Herniations ◽

Poor Outcomes ◽

Lower Lumbar

Upper lumbar (L1–2, L2–3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1–2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.

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Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation with Modic Changes via a Transforaminal Approach: A Retrospective Study

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e601 ◽

2019 ◽

Vol 6 (22;6) ◽

pp. E601-E608

Author(s):

Ya-Wei Li

Keyword(s):

Back Pain ◽

Retrospective Study ◽

Lumbar Disc ◽

Leg Pain ◽

Recurrence Rates ◽

Transforaminal Approach ◽

Modic Type ◽

Endoscopic Lumbar Discectomy

Background: The surgical selection for patients with lumbar disc herniation (LDH) with Modic changes (MCs) is still contentious. Percutaneous endoscopic lumbar discectomy via a transforaminal approach (TF-PELD) as a representative minimally invasive spine surgery technique for LDH has been standardized. However, its efficacy has not been thoroughly described in the patients with LDH with MCs. Objectives: The goal of this study was to assess the clinical outcomes of TF-PELD in the treatment of LDH and MCs. Study Design: Retrospective study. Setting: Inpatient surgery center. Methods: From January 2015 to December 2016, 276 patients with LDH showing normal or MCs signals in their bone marrow in our hospital were enrolled in this retrospective study. All patients suffered low back and leg pain because of LDH and underwent the TF-PELD procedure. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) for functional status assessment, and modified MacNab criteria for patient satisfaction. Results: A total of 182 patients showed normal intensity, 44 patients showed Modic type 1 signals, and 50 patients showed Modic type 2 signals before surgery. The postoperative VAS and ODI scores were significantly improved compared with those preoperatively among the groups. In the Modic type 1 and 2 signals groups, however, the postoperative VAS scores for back pain and ODI scores showed an upward trend with the follow-up time extending. The recurrence rates were 4.4%, 9.1%, and 8.0% in the normal, Modic type 1 and 2 signals groups, respectively. The recurrence rates and satisfaction rates showed no significant difference among the groups at the final follow-up. Limitations: This study has a small sample size and the follow-up period was too short. There is no comparison with other therapeutic options such as fusion surgery or the lack of any other treatment. Conclusions: TF-PELD is an option for treatment of patients with LDH even if the patients show MCs. However, the postoperative back pain and functional status have the trend of deterioration with the time extending in patients with MCs, especially in the Modic type 1 signals

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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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Transforaminal 360° lumbar endoscopic foraminotomy in postfusion patients: technical note and case series

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine21206 ◽

2021 ◽

pp. 1-7

Author(s):

Albert E. Telfeian ◽

Ashwin Veeramani ◽

Andrew S Zhang ◽

Matthew S. Quinn ◽

Alan H. Daniels

Keyword(s):

Minimally Invasive ◽

High Speed ◽

Lumbar Fusion ◽

Case Series ◽

Visual Analog Scale Score ◽

Technical Note ◽

Leg Pain ◽

Decompression Surgery ◽

Foraminal Stenosis

OBJECTIVE This report describes a minimally invasive lumbar foraminotomy technique that can be applied in patients who underwent complex spine decompression procedures or in patients with severe foraminal stenosis. METHODS Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period between 2014 and 2019. Transforaminal endoscopic foraminal decompression surgery using a high-speed endoscopic drill was performed in 34 patients who had previously undergone fusions at the treated level. RESULTS At 2-year follow-up, the mean (± SD) preoperative visual analog scale score for leg pain and the Oswestry Disability Index improved from 7.1 (± 1.5) and 40.1% (± 12.1%) to 2.1 (± 1.9) and 13.6% (± 11.1%). CONCLUSIONS A minimally invasive, awake procedure is presented for the treatment of severe lumbar foraminal stenosis in patients with lumbar radiculopathy after lumbar fusion.

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Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.6-wit.4880 ◽

2021 ◽

Vol 37 (6-WIT) ◽

Author(s):

Bin Chen ◽

Zengfeng Du

Keyword(s):

Back Pain ◽

Pain Score ◽

Nucleus Pulposus ◽

Spinal Surgery ◽

Leg Pain ◽

Low Back ◽

Endoscopic Imaging ◽

Transforaminal Approach ◽

Interlaminar Approach

Original Article Bin Chen1, Zengfeng Du2 ABSTRACTObjective: To explore the technical points, approach selection and short-term clinical efficacy of PELD through the intervertebral foramina or interlaminar approach in the treatment of highly shifted LDH. Methods: From September 2018 to June 2020, 19 patients with highly shifted LDH were treated with PELD in The First Hospital of Yulin. It included, 10 males and 9 females; aged 34 to 69 years, with an average of 48 years. Thirteen cases were shifted to the caudal side, and six cases were shifted to the head side. The responsible segments included L3/41 cases, L4/511 cases, and L5/S17 cases. All patients had symptoms of low back and leg pain. The Sowerby dysfunction index (ODI) was 63.5%±10.7% before surgery. The visual analogue scale of pain (VAS) was low back pain (5.2±2.1) and leg pain (7.1±2.4). 14 cases used transforaminal approach, and 5 cases used translaminar approach. Results: All cases completed the operation successfully, the operation time was 60~110min, with an average of 70 minutes. The follow-up time ranged from 6 to 42 months, with an average of 20.8 months. At the last follow-up, ODI was 10.8%±6.8%, VAS back pain score (2.1±1.1) and leg pain score (1.8±0.9). Compared with preoperative, ODI and VAS scores were significantly decreased (P<0.05). The results of Mac Nab method were 14 excellent, four good, and one fair. During the follow-up period, one patient’s leg pain symptoms recurred seven days after operation. No further hernia was found under intervertebral foramen. The symptoms disappeared after two weeks of symptomatic treatment such as swelling and analgesia, and he was discharged. No perioperative complications such as infection and nerve root injury occurred. Conclusion: When PELD is used to treat high-displacement LDH, the choice of transforaminal approach or interlaminar approach needs to be personalized according to the LDH segment and the direction of displacement. KEYWORDS: Spinal Surgery, Spinal Endoscopic Imaging, Inter Laminar Spine, Nucleus Pulposus Removal. doi: https://doi.org/10.12669/pjms.37.6-WIT.4880How to cite this:Chen B, Du Z. Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine. Pak J Med Sci. 2021;37(6):1667-1671. doi: https://doi.org/10.12669/pjms.37.6-WIT.4880 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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