Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy

Tonosu, Juichi; Oshima, Yasushi; Shiboi, Ryutaro; Hayashi, Akihiko; Takano, Yuichi; Inanami, Hirohiko; Koga, Hisashi

doi:10.21037/jss.2016.11.05

Cited by 25 publications

(32 citation statements)

References 25 publications

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“…There are several recognized percutaneous endoscopic approaches to LDHs: interlaminar, transforaminal, posterolateral, and transiliac [77,78]. As an aggregate group, endoscopic discectomy is associated with decreased operative time and less blood loss with no increase in overall complications, reoperation rates, or wound infection when compared to open discectomy [79].…”

Section: Minimally Invasive Surgerymentioning

confidence: 99%

“…The interlaminar approach has the advantage of direct insertion under endoscopic guidance [78,82]. However, compared to the aforementioned approaches, interlaminar resection requires nerve root and thecal sac retraction which may present a particular challenge in large LDH [78].…”

Section: Interlaminar Approachmentioning

confidence: 99%

“…However, compared to the aforementioned approaches, interlaminar resection requires nerve root and thecal sac retraction which may present a particular challenge in large LDH [78]. However, both Soman et al and Tonusu et al demonstrate significant improvement in outcome indices following LDH resection via this method [78,82].…”

Section: Interlaminar Approachmentioning

confidence: 99%

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Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

207

202

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Purpose of Review Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. Recent Findings There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Summary Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.

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Section: Minimally Invasive Surgerymentioning

confidence: 99%

Section: Interlaminar Approachmentioning

confidence: 99%

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Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

207

202

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“…In the same way, although PED allows removal of an LDH from both the shoulder and axillary portions of a nerve root, compared with removal only from the shoulder portion with a conventional open approach, the decision to proceed via the shoulder or axillary portion requires careful consideration of the anatomical relationships between the LDH and the involved nerve root. [5][6][7][8] As the endoscope is inserted through the IL window, the positional relationships between the IL window size, nerve root, and the LDH must be clearly determined.…”

Section: Introductionmentioning

confidence: 99%

“…Conventional imaging modalities, such as plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI), have been used independently as a reference for preoperative planning. [5][6][7][8] However, the three-dimensional (3D) positional relationship of the local anatomy to the IL window cannot be easily determined from twodimensional images. During our early training period, when using conventional imaging modalities, we experienced unexpected additional partial laminectomies because the lateral border of the affected nerve root could not be identified in the partial window opening of the ligamentum flavum, requiring extra operative time.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Endoscopic Diskectomy using an Interlaminar Approach Based on 3D CT/MR Fusion Imaging

Hirayama¹,

Hashimoto²

2018

J Neurol Surg A Cent Eur Neurosurg

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Background With effective preoperative planning, percutaneous endoscopic diskectomy (PED) via an interlaminar approach (PED-IL) can reduce the need for partial laminectomy. Our aim was to assess the clinical outcomes of PED-IL, planned using three-dimensional fusion of computed tomography and magnetic resonance (3D CT/MR) images. Material and Methods Our retrospective analysis was based on data from 102 patients (66 were men) treated by PED-IL. Preoperative planning was based on the positional relationship between the nerve root and the lumbar disk herniation, visualized on 3D CT/MR fusion images through a simulated IL window. Two approaches were planned: type I, via a partial window opening of the ligamentum flavum, and type II, via a partial IL window opening and partial laminectomy. Decisions were then made to approach the herniation from the shoulder (subtype s) or axillary (subtype a) portion of the nerve, or we used a combination of both approaches (subtype a + s). Operative time and the pre- to postsurgical change in pain and pain-related disability scores (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores) were evaluated. The number of cases in which the preoperative planned surgery was modified intraoperatively and the incidence of complications were also evaluated. Results A type I approach was planned in 30 cases (29.4%) and type II in 72 cases (70.6%). Intraoperative change from type I to type II was required in two cases. The mean operative time was longer for type II than type I procedures. Pain and pain-related disability scores improved in all patients, and only one case of dural sleeve damage was identified. Conclusions Preoperative planning using a simulated IL window to visualize the 3D regional anatomy is effective in predicting the feasibility of a PED-IL.

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Current concepts for lumbar disc herniation

Benzakour¹,

Igoumenou

Mavrogenis

et al. 2018

International Orthopaedics (SICOT)

117

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Purpose To present the pathophysiology, biology, clinical presentation, diagnosis, and current treatment options for lumbar disc herniation. Methods A thorough literature search was undertaken in PubMed and Google Scholar to summarize the current knowledge and future perspectives on lumbar disc herniation. Results Several changes in the biology of the intervertebral disc are thought to contribute to disc herniation; nevertheless, the exact inciting event leading to disc herniation is yet to be discovered. Non-operative treatments have stood the test of time as the first-line treatment for most patients with lumbar disc herniation; however, operative treatment remains the current gold standard, with minimally invasive endoscopic microdiscectomy techniques showing best results with respect to postoperative pain and function. Conclusions The exact event leading to disc herniation remains unclear. Non-operative treatments should be the first-line treatment for most patients with lumbar disc herniation. Operative treatment remains the current gold standard, with minimally invasive endoscopic microdiscectomy techniques showing best results with respect to postoperative pain and function. Regenerative medicine is promising.

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Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy

Cited by 25 publications

References 25 publications

Lumbar Disc Herniation

Lumbar Disc Herniation

Percutaneous Endoscopic Diskectomy using an Interlaminar Approach Based on 3D CT/MR Fusion Imaging

Current concepts for lumbar disc herniation

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