Prevention of Development of Postoperative Dysesthesia in Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Intracanalicular Lumbar Disc Herniation: Floating Retraction Technique
27 January 2012 (online)
Transforaminal percutaneous endoscopic lumbar discectomy (PELD) has become a routine surgical procedure because it is minimally invasive. Perioperative complications such as dural injury, infection, nerve root irritation and recurrence can occur not only with PELD, but also with conventional open microsurgery. In contrast, post-operative dysesthesia (POD) due to existing dorsal root ganglion (DRG) injury is a unique complication of PELD. When POD occurs, even if the traversing root has been successfully decompressed, it hinders swift recovery and delays the return to daily routines. Thus, prevention of POD is the key to successful and widespread use of PELD.
Material and Methods:
From January 2006 to December 2008, 154 patients underwent percutaneous endoscopic discectomy by floating retraction technique at 160 disc levels under local anesthesia. This approach towards the superomedial border of the lower pedicle and the cannula can be placed by gentle retraction of the root with perineural fat instead of direct compression of dorsal root ganglion. The clinical outcomes were assessed using the Visual Analogue Scale (VAS, 0–10 point) for radicular pain and low back pain, and using the Oswestry Disability Index (ODI) for functional status. Perioperative complications and recurrence were reviewed.
The mean age was 45 years, the mean operative time was 36 min and the mean follow-up period was 3.4 years. The mean hospital stay for endoscopic discectomy was 1.8 days. No patient underwent repeated PELD or convert microsurgery by incomplete removal of the ruptured particle. All patients experienced early relief of symptoms, as determined by VAS and ODI. No patient developed POD. 1 patient experienced dural injury. There was 1 case of discitis. The recurrence rate was 1.95% (3 patients).
Transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation is a safe and effective procedure. The floating retraction technique is recommended to avoid development of POD.
- 1 Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine: A preliminary report. Clin Orthop 1983; 174: 127-132
- 2 Retten S, Komp M, Merk H et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniation via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 2007; 6: 521-530
- 3 Yeung AT, Tsou PM. Posterolateral endoscopic escision for lumbar disc herniation: Surgical technique, outcome, and complication in 307 consecutive cases. Spine 2002; 27: 722-731
- 4 Lee HY, Ahn Y, Lee S et al. Percutaneous endoscopic lumbar discectomy. J Korean Assoc for the Study of Spinal Pain 2004; 5: 71-77
- 5 Tzaan WC. Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung Med J 2007; 30: 226-234
- 6 Yeung AT, Yeung CA. Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am 2007; 38: 363-372
- 7 Lee SH, Chung SE, Ahn Y et al. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis. Mt Sinai J Med 2006; 73: 795-801
- 8 Liu WC, Choi G, Lee SH et al. Radiological findings of spinal schwannomas and meningiomas: focus on discrimination of two disease entities. Eur Radiol 2009; 19: 2707-2715
- 9 Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Res 1999; 21: 39-42
- 10 Lee DY, Lee SH. Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo). 2008; 48: 383-388 discussion 388–389
- 11 Jhala A, Mistry M. Endoscopic lumbar discectomy: Experience of first 100 cases. Indian J Orthop 2010; 44: 184-190
- 12 Lysoń T, Mariak Z, Jadeszko M et al. Results of Destandau microendoscopic lumbar discectomy. Neurol Neurochir Pol 2008; 42: 105-111
- 13 Tsou PM, Yeung AT. Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique.. Spine J 2002; 2: 41-48
- 14 Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgicasl discectomy. J Neurosurg 1993; 78: 216-225
- 15 Maramatsu K, Hachiya Y, Morita C. Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love’s method. Spine 2001; 26: 1599-1605
- 16 Osman SG, Marsolais EB. Posterolateral arthroscopic discectomies of the thoracic and lumbar spine. Clin Orthop Relat Res 1994; 304: 122-129
- 17 Lee S, Kim SK, Lee SH et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J 2007; 16: 431-437
- 18 Lee SH, Kang BU, Ahn Y et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine (Phila Pa 1976). 2006; 31: E285-E290
- 19 Ahn Y, Lee SH, Park WM et al. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 2004; 15: E326-E332
- 20 Ditsworth DA. Endoscopic tranforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canal. Surg Neurol 1998; 49: 588-597
- 21 Kim DY, Lee SH, Lee HY et al. Validation of the Korean version of the Oswestry disability index. Spine 2005; 30: E123-E127
- 22 Lee DY, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation: surgical outcomes in 46 consecutive patients. Mt Sinai J Med 2006; 73: 864-870
- 23 Lee HY, Ahn Y, Kim DY et al. Percutaneous ventral decompression for L4-L5 degenerative spondylolisthesis in medically compromised elderly patients: technical case report. Neurosurgery 2004; 55: E435-E459
- 24 Lee HY, Lee SH, Shin SW. Percutaneous ventral decompression for degenerative lumbar spondylolisthesis in medically compromised geriatric patients. Joint Dis Rel Surg 2005; 16: 133-136
- 25 Ruetten S, Komp M, Merk H et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008; 33: 931-939
- 26 Ahn Y, Lee SH, Lee JH et al. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir 2009; 151: 199-206