Effect of Dorsal Root Ganglion Retraction in Endoscopic Lumbar Decompressive Surgery for Foraminal Pathology: A Retrospective Cohort Study of Interlaminar Contralateral Endoscopic Lumbar Foraminotomy and Discectomy versus Transforaminal Endoscopic Lumbar Foraminotomy and Discectomy

Kim, Hyeun Sung; Kim, Ji Yeon; Wu, Pang Hung; Jang, Il‐Tae

doi:10.1016/j.wneu.2020.12.176

Cited by 23 publications

(19 citation statements)

References 13 publications

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“…Upper and Lower Lumbar Spine With Each Zone of Disc Herniation A total of 10 articles [31][32][33][34][35][36][37][38][39][40] advocated for the TELD approach at higher and lower lumbar levels with each zone (central, subarticular, foraminal, or extraforaminal zone) of the herniated disc. Only 1 study, conducted by Li and Zhou, 37 reported that TELD could be performed in all zones and at all lumbar levels of herniated discs.…”

Section: Transforaminal Endoscopic Lumbar Discectomy Approachmentioning

confidence: 99%

Full-Endoscopic Lumbar Discectomy Approach Selection

Kotheeranurak

Liawrungrueang

Quillo-Olvera

et al. 2023

Spine

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Study Design. A systematic review of the literature to develop an algorithm formulated by key opinion leaders.Objective. This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. Summary of Background Data. Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. Materials and Methods. A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). Results. In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. Conclusions. The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.

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Section: Transforaminal Endoscopic Lumbar Discectomy Approachmentioning

confidence: 99%

Full-Endoscopic Lumbar Discectomy Approach Selection

Kotheeranurak

Liawrungrueang

Quillo-Olvera

et al. 2023

Spine

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“…The paraspinal or transforaminal endoscopic approach is commonly used to treat lumbar foraminal and extraforaminal stenoses. In cases of severe osseous lumbar foraminal stenosis, sufficient bone spur removal at the ventral foraminal area can induce postoperative dysesthesia due to excessive retraction of the dorsal root ganglion during ventral foraminal decompres-sion [4]. These difficulties are pronounced at the L5-S1 level because it has a high iliac crest, inclination of the disc space, and wide facet joints overlapping the disc space [3].…”

Section: Discussionmentioning

confidence: 99%

“…This technique is effective at all lumbar levels and more beneficial at the L5-S1 level with a wide facet joint, longer foraminal length, and inclination of the disc space [3,5]. Furthermore, several patients with recurrent foraminal stenosis have been successfully treated using the ICELF technique [4].…”

Section: Discussionmentioning

confidence: 99%

“…An advancing endoscopic approach was recently developed to treat contralateral coexisting lateral recess stenosis and foraminal and extraforaminal stenosis via a unidirectional interlaminar contralateral approach using full endoscopy and biportal endoscopy [1][2][3]. This technique showed favorable outcomes in the lumbar levels and reported more benefits at the L5-S1 level [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Full Endoscopic Interlaminar Contralateral Lumbar Foraminotomy for Recurrent L5-S1 Foraminal-extraforaminal Stenosis: A Case Report with a Technical Note

Kim

Lee

Kim

et al. 2022

J Minim Invasive Spine Surg Tech

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After endoscopic lumbar foraminotomy, decreased disc height commonly causes foraminal restenosis and accompanying lateral recess stenosis. Interlaminar contralateral endoscopic lumbar foraminotomy can be used to treat multiple recurrent lesions instead of fusion surgery. Dorsal foraminal-extraforaminal decompression is challenging because of severe perineural adhesions. Therefore, neural decompression should be focused on the ventral foraminal expansion along the virgin dissection plane between the exiting nerve root and ventral foraminal pathologies. The prominent bony spur and herniated disc were removed using an endoscopic drill and forceps. As the foramen was enlarged, the endoscope was introduced deeper through the caudal-ventral foramen space to explore the extraforaminal and far-out lesions. Postoperatively, neurological deficits of L5 radiculopathy and radiating leg pain improved. The expanded foraminal-extraforaminal space was well maintained without progression of lateral wedging on the one-year follow-up images. We successfully treated recurrent foraminal-extraforaminal stenosis and combined lateral recess stenosis using the full endoscopic interlaminar contralateral approach at the L5-S1 level. This technique may be an alternative surgical method to treat the recurrent foraminal-extraforaminal stenosis in the collapse of the L5-S1 neuroforamen. However, this technique should be considered in highly selected patients unsuitable for fusion operations.

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“…This novel foraminal decompression method has evolved using different surgical devices such as micropunches, bone reamers, side-firing lasers, and endoscopic burrs. Although the clinical results of current FELF are comparable to those of open foraminotomy owing to technical advancements, the learning curve is steep, and the entry barrier is still high for standard spine surgeons [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Full-Endoscopic Lumbar Foraminotomy for Foraminal Stenosis in Spondylolisthesis: Two-Year Follow-Up Results

Rhee

Ahn²

2022

Diagnostics

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Full-endoscopic lumbar foraminotomy (FELF) under local anesthesia has been developed as a minimally invasive alternative for lumbar foraminal stenosis. Some authors have described this technique for treating various lumbar spondylolisthesis. However, few studies have reported the outcomes of FELF for foraminal stenosis in patients with stable spondylolisthesis. This study aimed to demonstrate the specific technique and clinical outcomes of FELF for foraminal stenosis in patients with spondylolisthesis. Twenty-three consecutive patients with foraminal stenosis and stable spondylolisthesis were treated with FELF. Among them, 21 patients were followed up for 2 years. Full-endoscopic foraminal decompression via the transforaminal approach was performed by a senior surgeon. Clinical outcomes were evaluated using the visual analog pain score (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. The VAS and ODI scores significantly improved at the two-year follow-up. The global effects were excellent in six patients (28.6%), good in 13 (61.9%), and fair in two (9.5%). Therefore, all patients showed clinical improvement, with a success (excellent/good) rate of 90.5%. No significant surgical complications or signs of further instability were observed. FELF can be used for foraminal stenosis in patients with stable spondylolisthesis. A specialized surgical technique is required for foraminal decompression of spondylolisthesis.

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Effect of Dorsal Root Ganglion Retraction in Endoscopic Lumbar Decompressive Surgery for Foraminal Pathology: A Retrospective Cohort Study of Interlaminar Contralateral Endoscopic Lumbar Foraminotomy and Discectomy versus Transforaminal Endoscopic Lumbar Foraminotomy and Discectomy

Cited by 23 publications

References 13 publications

Full-Endoscopic Lumbar Discectomy Approach Selection

Full-Endoscopic Lumbar Discectomy Approach Selection

Full Endoscopic Interlaminar Contralateral Lumbar Foraminotomy for Recurrent L5-S1 Foraminal-extraforaminal Stenosis: A Case Report with a Technical Note

Full-Endoscopic Lumbar Foraminotomy for Foraminal Stenosis in Spondylolisthesis: Two-Year Follow-Up Results

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