Foraminoplastic Superior Vertebral Notch Approach with Reamers in Percutaneous Endoscopic Lumbar Discectomy : Technical Note and Clinical Outcome in Limited Indications of Percutaneous Endoscopic Lumbar Discectomy

Abstract

To describe the details of the foraminoplastic superior vertebral notch approach (FSVNA) with reamers in percutaneous endoscopic lumbar discectomy (PELD) and to demonstrate the clinical outcomes in limited indications of PELD. Retrospective data were collected from 64 patients who underwent PELD with FSVNA from August 2012 to April 2014. Inclusion criteria were high grade migrated disc, high canal compromised disc, and disc protrusion combined with foraminal stenosis. The clinical outcomes were assessed using by the visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. Complications related to the surgery were reviewed. The procedure used a unique approach, using the superior vertebral notch as the target and performing foraminoplasty with only reamers under C-arm control. The mean age of the 55 female and 32 male patients was 52.73 years. The mean F/U period was 12.2±4.2 months. Preoperative VAS (8.24±1.25) and ODI (67.8±15.4) score improved significantly at the last follow-up (VAS, 1.93±1.78; ODI, 17.14±15.7). Based on the modified MacNab criteria, excellent or good results were obtained in 95.3% of the patients. Postoperative transient dysthesia (n=2) and reoperation (n=1) due to recurred disc were reported. PELD with FSVNA could be a good method for treating lumbar disc herniation. This procedure may offer safe and efficacious results, especially in the relatively limited indications for PELD.

Percutaneous Endoscopic Removal of Extruded Centering Pin in Lumbar Artificial Disc Causing Postoperative Radiculopathy: A Case Report

“…We observed coverage of 82.7% of the endplate on the lateral radiograph and 67.1% coverage on the anteroposterior radiograph. The extrusion of marker pin might be due to chronic rim impingement during normal flexion-extension or lateral flexion movements as reported in previous studies 10,14,16,18) . Regardless of excellent surgical technique and precise insertion of the prosthesis, the extrusion of the centering pin marker, a component in TDR implant, might imply the lack of durability in TDR.…”

“…Endoscopic operations have become standard in various areas such as arthroscopy and laparoscopy. Herniated discs and stenosis of the lumbar and cervical spine can now also be operated fully endoscopically using various accesses and techniques 2,5,9,10,14) . We chose the percutaneous endoscopic technique as the rescue procedure to remove the extruded wire marker in this case.…”

Posterolateral percutaneous endoscopic discectomy with free-running electromyography monitoring under general anesthesia

“…[13,14] Sometimes partial facetectomy and outside-in technique is required for LDH combined with foraminal stenosis to prevent ENR injury. [15][16][17][18][19] From our experience, these cases represented less than one third of the total cases and all successfully completed PLPED. The posterolateral approach is able to remove the migrated foraminal LDH except for the high grade upward migration at L5/S1 affected by iliac crest.…”

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

“…All these causes pressurize the nerve root which leads to the disease. The purpose of intervention in this disease is to decrease the pressure and tension applied on the nerve by removing the source of pressure [6][7][8][9][10][11][12]. The percutaneous foraminotomy introduced in this case report is a newly developed minimally invasive device that reduces pressure on the nerve root as well as the blood vessels in the neural canal.…”