Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level.

Kubaszewski, Łukasz; Kaczmarczyk, Jacek; Nowakowski, Andrzej; Sulewski, Adam

doi:10.5114/wiitm.2014.40186

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Foraminoplasty has been reported as a useful surgical strategy in degenerative lumbar foraminal stenosis, in which the nerve root is entrapped in a narrowed foramen [7, 12, 15, 21, 23, 24]. Traditionally, foraminoplasty could be categorized into two classifications: fluoroscopy-dependent or endoscopy-dependent.…”

Section: Discussionmentioning

confidence: 99%

Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

Hou

Jian

et al. 2018

BioMed Research International

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Purpose Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.

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Section: Discussionmentioning

confidence: 99%

Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

Hou

Jian

et al. 2018

BioMed Research International

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“…Nevertheless, comparisons of incision length, operative time and blood loss volume demonstrated the superiority of the MIDLF procedure [10]. In general, the range of minimally invasive spine surgery techniques has several proven advantages, including less blood loss, less need of transfusion, less postoperative back pain, shorter recovery time to ambulation, and shorter length of hospital stay [11, 12]. …”

Section: Discussionmentioning

confidence: 99%

Midline lumbar fusion using cortical bone trajectory screws. Preliminary report.

Bielecki

Kunert

Prokopienko

et al. 2016

Videosurgery and Other Miniinvasive Techniques

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IntroductionMidline lumbar fusion (MIDLF) using cortical bone trajectory is an alternative method of transpedicular spinal fusion for degenerative disease. The new entry points’ location and screwdriving direction allow the approach-related morbidity to be reduced.AimTo present our preliminary experience with the MIDLF technique on the first 5 patients with lumbar degenerative disease and with follow-up of at least 6 months.Material and methodsRetrospective analysis was performed on the first 5 patients with foraminal (4) or central (1) stenosis operated on between December 2014 and February 2015. Three patients were fused at L4–L5 and two at the L5–S1 level.ResultsNo intra- or post-operative complications occurred with this approach. An improvement regarding the leading symptom in the early postoperative period (sciatica 4/4, claudication 1/1) was achieved in all patients. The mean improvements in the visual analogue scale for low back and leg pain were 2.2 and 4.8 respectively. The mean Oswestry Disability Index scores were 52% (range: 16–82%) before surgery and 33% (range: 12–56%) at 3-month follow-up (mean improvement 19%). At the most recent follow-up, 4 patients reported the maintenance of the satisfactory result. The early standing and follow-up X-rays showed satisfactory screw placement in all patients.ConclusionsIn our initial experience, the MIDLF technique seems to be an encouraging alternative to traditional transpedicular trajectory screws when short level lumbar fusion is needed. Nevertheless, longer observations on larger groups of patients are needed to reliably evaluate the safety of the method and the sustainability of the results.

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“…This risk can be avoided by confirming the trajectory through the foraminal view in the O-arm, and estimating the distance from the nerve root to the working cannula [ 8 ]. Some surgeons prefer the foraminoplastic technique for undercutting the face joint bone to widen and decompress the exit nerve root, especially for lumbar disc herniation at the L5–S1 level [ 9 – 11 ]. If so, then in the multiplanar view of the O-arm the quality of the bony resection can be checked [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional intraoperative imaging with O-arm to establish a working trajectory in percutaneous endoscopic lumbar discectomy.

Shu¹,

Tao²,

Zhu³

et al. 2015

Videosurgery and Other Miniinvasive Techniques

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IntroductionSuccessful percutaneous endoscopic lumbar discectomy (PELD) requires an appropriate working trajectory. Due to the complexity of spinal anatomy, this is difficult to verify with conventional 2-dimensional fluoroscopy.AimHere we assessed the feasibility and utility of the O-arm for establishing the working trajectory for PELD.Material and methodsWe retrospectively reviewed the records of 89 patients with lumbar disc herniation who underwent PELD using the O-arm. The working trajectory was evaluated with standard fluoroscopic images or 3-dimensional, volumetric computed tomography scan. Based on the detail provided by the multiplanar view, we confirmed the ideal working trajectory and adjusted the surgical approach accordingly.ResultsAt the 12-month follow-up, based on MacNab's criteria, 85.9% of patients showed an excellent or good outcome. There were no major complications.ConclusionsThe O-arm provides detailed multiplanar intraoperative high-quality imaging for PELD, and enables the surgeon to ascertain the surgical anatomy, determine the optimal working trajectory, and improve the accuracy of surgery.

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Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level.

Cited by 5 publications

References 10 publications

Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

Midline lumbar fusion using cortical bone trajectory screws. Preliminary report.

Three-dimensional intraoperative imaging with O-arm to establish a working trajectory in percutaneous endoscopic lumbar discectomy.

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