Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 3/2018

01-07-2018 | Case Report

Percutaneous endoscopic lumbar discectomy for high-grade down-migrated disc using a trans-facet process and pedicle-complex approach: a technical case series

Authors: Qing-Feng Hu, Hao Pan, Yi-You Fang, Gao-Yong Jia

Published in: European Spine Journal | Special Issue 3/2018

Login to get access

Abstract

Purpose

The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach.

Methods

Three patients with high-grade down-migrated L3–4 and L4–5 disc herniation presented to our hospital. Each underwent PELD via a facet process and pedicle complex approach to remove the herniated fragment and achieve complete decompression of the nerve root.

Results

Patients’ symptoms were relieved. Postoperative magnetic resonance imaging showed root decompression. Follow-up 12-month computed tomography revealed no pedicle or facet fracture and healing of the pedicle complex and facet process bone tunnel.

Conclusion

PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.
Literature
1.
Hijikata S (1989) Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop Relat Res 238:9–23
2.
Kambin P, Brager MD (1987) Percutaneous posterolateral discectomy. Anatomy and mechanism. Clin Orthop Relat Res 223:145–154
3.
Kambin P, O’Brien E, Zhou L, Schaffer JL (1998) Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 347:150–167CrossRef
4.
Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731CrossRefPubMed
5.
Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976) 31:E890–E897CrossRef
6.
Ruetten S, Komp M, Godolias G (2005) 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 (Phila Pa 1976) 30:2570–2578CrossRef
7.
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:931–939CrossRef
8.
Ruetten S, Komp M, Merk H, Godolias G (2009) Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22:122–129CrossRefPubMed
9.
Lew SM, Mehalic TF, Fagone KL (2001) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 94:216–220PubMed
10.
Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S (2013) The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician 16:335–344PubMed
11.
12.
Hermantin FU, Peters T, Quartararo L, Kambin P (1999) A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 81:958–965CrossRefPubMed
13.
Tsou P, Yeung A (2002) Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J 2:41–48CrossRefPubMed
14.
Choi G, Lee S, Bhanot A, Raiturker PP, Chae YS (2007) Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine (Phila Pa 1976) 32:E93–99CrossRef
15.
Choi G, Lee S, Raiturker PP, Lee S, Chae YS (2006) Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5–S1 using a rigid working channel endoscope. Neurosurgery 58:59–68
16.
Choi G, Kim JS, Lokhande P, Lee SH (2009) Percutaneous endoscopic lumbar discectomy by transiliac approach: a case report. Spine (Phila Pa 1976) 34:E443–E446CrossRef
17.
Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, Shin SW, Kang HY (2006) Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine (Phila Pa 1976) 31:E285–E290CrossRef
18.
19.
20.
Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, Shin SW (2007) Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J 16:431–437CrossRefPubMed
21.
Cyron BM, Hutton WC (1978) The fatigue strength of the lumbar neural arch in spondylolysis. J Bone Joint Surg Br 60-B:234–238CrossRefPubMed
22.
Ivanov AA, Faizan A, Ebraheim NA, Yeasting R, Goel VK (2007) The effect of removing the lateral part of the pars interarticularis on stress distribution at the neural arch in lumbar foraminal microdecompression at L3–L4 and L4–L5: anatomic and finite element investigations. Spine (Phila Pa 1976) 32:2462–2466CrossRef
23.
Reinshagen C, Ruess D, Molcanyi M, Redjal N, Walcott BP, Goldbrunner R, Rieger B (2015) A novel translaminar crossover approach for pathologies in the lumbar hidden zone. J Clin Neurosci 22:1030–1035CrossRefPubMed
24.
Robertson PA, Stewart NR (2000) The radiologic anatomy of the lumbar and lumbosacral pedicles. Spine (Phila Pa 1976) 25(6):709–715CrossRef
25.
Kadioglu HH, Takci E, Levent A, Arik M, Aydin IH (2003) Measurements of the lumbar pedicles in the Eastern Anatolian population. Surg Radiol Anat 25:120–126CrossRefPubMed
26.
Lien SB, Liou NH, Wu SS (2007) Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16:1215–1222CrossRefPubMed
27.
Santoni BG, Hynes RA, McGilvray KC, Rodriguez-Canessa G, Lyons AS, Henson MA, Womack WJ, Puttlitz CM (2009) Cortical bone trajectory for lumbar pedicle screws. Spine J 9:366–373CrossRefPubMed
28.
Aepli M, Mannion AF, Grob D (2009) Translaminar screw fixation of the lumbar spine: long-term outcome. Spine (Phila Pa 1976) 34:1492–1498CrossRef
Metadata
Title
Percutaneous endoscopic lumbar discectomy for high-grade down-migrated disc using a trans-facet process and pedicle-complex approach: a technical case series
Authors
Qing-Feng Hu
Hao Pan
Yi-You Fang
Gao-Yong Jia
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 3/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5365-3

Other articles of this Special Issue 3/2018

European Spine Journal 3/2018 Go to the issue

Case Report

Bilateral vocal cord palsy after a posterior cervical laminoplasty

Case Report

Iatrogenic dural tear in endoscopic lumbar spinal surgery: full endoscopic dural suture repair (Youn’s technique)

Case Report

Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature

Case Report

Transforaminal endoscopic decompression for thoracic spinal stenosis under local anesthesia

Case Report

Delayed chance fracture pattern injury in a case of skeletal fluorosis

Case Report

Recurrence of ossification of ligamentum flavum at the same intervertebral level in the thoracic spine: a report of two cases and review of the literature