A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop

Abstract

Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy.

Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients

“…However, application of TED in treating LDH-induced common peroneal nerve paralysis is only restricted in case report 10. There are no reports on the large sample size study aiming at applying such surgical method exclusively in treating LDH-induced common peroneal nerve paralysis, and hence its safety and effectiveness remain unclear.…”

“…This has also provided new arenas for the surgical treatment of patients with LDH-induced common peroneal nerve paralysis. In 2016, Chun and Park10 reported the application of TED in treating one case with L5-S1 extreme lateral LDH-induced common peroneal nerve paralysis, whose anterior tibial muscle strength recovered to grade 5 after 6 weeks, postoperatively. However, there is no report regarding a large sample study on applying such procedure exclusively in LDH-induced common peroneal nerve paralysis yet, and hence its safety and effectiveness remain unclear.…”

A Radiographic Measurement of the Anterior Epidural Space at L4–5 Disc Level

“…the epidural area between the rear vertebral body and the anterior dural sac), relevant morphological study is deficient. Therefore, during the PLED, on removal of the herniated segment of L 5 S 1 , we selected cases with no lesion at the L 4–5 disc, by injecting iohexol at the pressure of 50 cm H 2 O, to expand the lower lumbar epidural space, then using X‐ray images to make radiological measurements on their morphological characteristics.…”

Application of percutaneous foraminotomy with a specially designed drill tip for foraminal stenosis patient - A case report -

“…At the L5-S1 level, approach may be extremely difficult as well, because the operative window narrows progressively because of the prominent iliac crest, wider disc space, and more oblique pedicles. In addition, the more coronally oriented facet joints at L5-S1 impede posterior or posterolateral access to the disc [15].…”