A Novel Trajectory for a Transpedicular Approach in the Treatment of a Highly Downward-Migrated Lumbar Herniation with a Full Endoscopic Technique

Abstract

BackgroundTo evaluate the clinical outcome of full endoscopic discectomy using a novel trajectory via a transpedicular approach.MethodThirty-five patients were enrolled in this retrospective study between July 2014 and October 2019 in the Beijing Haidian Hospital. All patients were treated with full-endoscopic lumbar discectomy via a transpedicular approach with an oblique trajectory. The imaging parameters, including pedicle height and angle of trajectory, were recorded. The preoperative and postoperative clinical data were collected for statistical analysis.ResultsAll patients underwent successful surgery without severe complications. We compared the visual analogue scale and Oswestry disability index scores before and after surgery. The differences were statistically significant (p < 0.05). According to the modified Macnab criteria, the good-to-excellent rate was 85.7% at the last follow-up. The average angles of trajectory in the sagittal and coronal planes were 34.5° ± 2.9° and 47.1° ± 5.0°, respectively.ConclusionThe new trajectory of the transpedicular approach with a full endoscopic technique for an extremely downward-migrated disc herniation showed excellent results in a small sample study. A precise surgical plan is required, comprising measurements of the pedicle height and angle of the bone tunnel.

The Biomechanics of the Transpedicular Endoscopic Approach

“…The endoscopic transpedicular approach is a valuable option in case in of high-grade downmigrated lumbar disc herniations 13–15 . Until now, its biomechanical consequence was unknown.…”

“…Krzok et al 11,12 first described the transpedicular approach to accessing highly downmigrated disc herniations, followed by a limited number of case studies with reported good clinical outcome 13,14,29 . Jiang et al 15 included 35 patients in a retroperspective study showing good clinical results and confirmed bony healing of the transpedicular hole with a CT scan six months postoperatively for all patients. None of the abovementioned publications 11–15,29 described severe complications, including a pedicle fracture.…”

“…Subsequently, access to the juxtapedicular epidural space is obtained, and the downward-migrated disc herniation can be removed. Recent case series and a small retroperspective study showed promising clinical results with a transpedicular approach 13–15 . Whether and to what extent such an approach has an adverse biomechanical effect on pedicle stability has not been investigated to date.…”

Modified lumbar foraminoplasty using a power-aided reciprocating burr for percutaneous transforaminal endoscopic lumbar discectomy: A technical note and clinical report

“…Percutaneous transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive surgical procedure performed while the patient is awake through an incision of no more than 1 cm in length. Compared with traditional open surgery, TELD is preferred due to the advantages of less pain, less paravertebral muscle injury, preservation of the posterior ligamentous, and faster recovery (1)(2)(3). Despite the remarkable evolution of endoscopic techniques and instrumentation, traditional TELD requires extensive training for surgeons to overcome its steep learning curve (4)(5)(6).…”

Current Status and research hotspots in the field of full endoscopic spine surgery: A bibliometric analysis

“…The reason for the rapid development of this technology is that, compared with traditional open spine surgery, FESS does not involve massive destruction of muscle tissue, there is no need for the destruction of synovial joints and vertebral plates, and it lessens the distraction of nerve roots and dural sacs which ensures maximum stability of the spinal segment and reduces the occurrence of long-term pain and discomfort due to spinal instability and other complications (5)(6)(7). After decades of development, the use of FESS has gradually expanded from simple lumbar disc herniation (DH) to lumbar spinal stenosis and instability treatment; from lumbar to cervical and thoracic spine treatment; from pure decompression to endoscopicassisted fusion techniques; and from the treatment of degenerative spine diseases to that of spinal trauma, infection, deformity, and tumors (8)(9)(10)(11). With the widespread popularity of FESS, the amount of research in this field is increasing.…”