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J Neurol Surg A Cent Eur Neurosurg 2020; 81(05): 379-386
DOI: 10.1055/s-0039-1700574
Original Article

Full Endoscopic Technique for High-Grade Up-Migrated Lumbar Disk Herniation via a Translaminar Keyhole Approach: Preliminary Series and Technical Note

Guang-Xun Lin
1   Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
,
Cheul-Woong Park
2   Department of Neurosurgery, Daejeon Woori Spine Hospital, Daejeon, South Korea
,
Tsz-King Suen
3   Department of Orthopaedics & Traumatology, Caritas Medical Centre, Kowloon West Cluster Hospital Authority, Hong Kong, PR China
,
Vit Kotheeranurak
4   Department of Orthopaedics, Spine Unit, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
,
Su-Gi Jun
2   Department of Neurosurgery, Daejeon Woori Spine Hospital, Daejeon, South Korea
,
Jin-Sung Kim 
5   Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Abstract

Background and Study Aims Technically and anatomically, accessing a high-grade migrated lumbar disk herniation (LDH) using traditional full endoscopic lumbar diskectomy (FELD) approaches (either transforaminal or interlaminar) is challenging. The objective of this study was to present an effective and safe surgical approach for high-grade up-migrated LDH by translaminar FELD.

Patients and Methods Thirteen patients with soft high-grade up-migrated LDH treated with a translaminar FELD between May 2015 and July 2018 were reviewed in this study. Five of these patients had very high-grade up-migration. Clinical outcomes were assessed including preoperative and postoperative visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria.

Results Overall, 7 of the 13 patients had disk-fragment migration at L4–L5: three at L5–S1, two at L3–L4, and the remaining one at L2–L3. In all cases, the highly up-migrated LDH was removed successfully through the translaminar approach, as confirmed by postoperative magnetic resonance imaging. The improvements of VAS for back and leg pain were 4.5 ± 0.9 to 1.3 ± 1.3 and 7.1 ± 1.0 to 1.6 ± 0.7, respectively (both p < 0.05). The ODI decreased from preoperative 41.9 ± 6.0 to postoperative 13.0 ± 4.1 (p < 0.05). According to the MacNab criteria, the satisfaction rate was 92.3% (excellent or good outcomes). None of the patients experienced any perioperative complications or recurrence during the follow-up period.

Conclusion Although full endoscopic technique via the translaminar keyhole route may not be used as a routine surgical approach, it could serve as a feasible alternative method for patients with highly up-migrated disk herniation.

Keywords

translaminar - full endoscopic lumbar diskectomy - migrated disk herniation - lumbar spine


Publication History

Received: 26 February 2019

Accepted: 03 July 2019

Article published online:
11 February 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 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 (06) 864-870
    PubMedGoogle Scholar
  • 2 Brouwer PA, Brand R, van den Akker-van Marle ME. , et al. Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. Spine J 2015; 15 (05) 857-865
    CrossrefPubMedGoogle Scholar
  • 3 Pan L, Zhang P, Yin Q. Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy: a randomised controlled trial. Int J Surg 2014; 12 (05) 534-537
    CrossrefPubMedGoogle Scholar
  • 4 Ebeling U, Reulen HJ. Are there typical localisations of lumbar disc herniations? A prospective study. Acta Neurochir (Wien) 1992; 117 (3-4): 143-148
    CrossrefPubMedGoogle Scholar
  • 5 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 (03) 431-437
    CrossrefPubMedGoogle Scholar
  • 6 Lee SH, Kang BU, Ahn Y. , et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine 2006; 31 (10) E285-E290
    CrossrefPubMedGoogle Scholar
  • 7 Schellinger D, Manz HJ, Vidic B. , et al. Disk fragment migration. Radiology 1990; 175 (03) 831-836
    CrossrefPubMedGoogle Scholar
  • 8 Choi G, Lee SH, Lokhande P. , et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 2008; 33 (15) E508-E515
    CrossrefPubMedGoogle Scholar
  • 9 Kim CH, Chung CK, Woo JW. Surgical outcome of percutaneous endoscopic interlaminar lumbar discectomy for highly migrated disk herniation. Clin Spine Surg 2016; 29 (05) E259-E266
    CrossrefPubMedGoogle Scholar
  • 10 Bernucci C, Giovanelli M. Translaminar microsurgical approach for lumbar herniated nucleus pulposus (HNP) in the “hidden zone”: clinical and radiologic results in a series of 24 patients. Spine 2007; 32 (02) 281-284
    CrossrefPubMedGoogle Scholar
  • 11 Osman SG, Nibu K, Panjabi MM, Marsolais EB, Chaudhary R. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine 1997; 22 (15) 1690-1695
    CrossrefPubMedGoogle Scholar
  • 12 Reinshagen C, Ruess D, Molcanyi M. , et al. A novel translaminar crossover approach for pathologies in the lumbar hidden zone. J Clin Neurosci 2015; 22 (06) 1030-1035
    CrossrefPubMedGoogle Scholar
  • 13 Ahn Y, Jang IT, Kim WK. Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clin Neurol Neurosurg 2016; 147: 11-17
    CrossrefPubMedGoogle Scholar
  • 14 Ruetten S, Komp M, Merk H, Godolias G. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 2009; 22 (02) 122-129
    CrossrefPubMedGoogle Scholar
  • 15 Choi KC, Lee DC, Shim HK, Shin SH, Park CK. A strategy of percutaneous endoscopic lumbar discectomy for migrated disc herniation. World Neurosurg 2017; 99: 259-266
    CrossrefPubMedGoogle Scholar
  • 16 Dezawa A, Mikami H, Sairyo K. Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine. Asian J Endosc Surg 2012; 5 (04) 200-203
    CrossrefPubMedGoogle Scholar
  • 17 Du J, Tang X, Jing X, Li N, Wang Y, Zhang X. Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation. Int Orthop 2016; 40 (06) 1247-1252
    CrossrefPubMedGoogle Scholar
  • 18 Xin Z, Liao W, Ao J. , et al. A modified translaminar osseous channel-assisted percutaneous endoscopic lumbar discectomy for highly migrated and sequestrated disc herniations of the upper lumbar: clinical outcomes, surgical indications, and technical considerations. BioMed Res Int 2017; 2017: 3069575
    PubMedGoogle Scholar
  • 19 Quillo-Olvera J, Akbary K, Kim JS. Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations. Acta Neurochir (Wien) 2018; 160 (08) 1603-1607
    CrossrefPubMedGoogle Scholar