Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations

Abstract

This technique allows to reach migrated herniations medially to the pedicle safely and effectively.

Transforaminal Endoscopic Surgery: Outside-In Technique

“…Krzok et al [ 15 - 17 ] described transpedicular endoscopic surgery for highly superiorly and inferiorly migrated disc herniation and facet cysts [ 18 ]. Further case reports of Uniyal et al [ 19 ] and Quillo-Olvera et al [ 20 ] confirmed the successful use of this burr hole technique, which allows direct access to the sequestration behind the pedicle.…”

“…10 ). In contrast to the first description of this technique by Krzok et al [ 15 - 17 ], access posterior to the transverse process was preferred, as reported by Quillo-Olvera et al [ 20 ].…”

“…10). In contrast to the first description of this technique by Krzok et al, [15][16][17] access posterior to the transverse process was preferred, as reported by Quillo-Olvera et al 20 By careful mallet blows, and lastly by manually advancing the Jamshidi needle (Fig. 10B, D), the medial border of the pedicle was passed.…”

Full Endoscopic Technique for High-Grade Up-Migrated Lumbar Disk Herniation via a Translaminar Keyhole Approach: Preliminary Series and Technical Note

“…If migrated fragments are located at the shoulder part of the upper nerve root, we recommend that another transpedicular approach be used. 19 4. Care should be taken to avoid damage to dura or nerve root when the lamina is opened with a drilling burr because at this region, it lacks the protection of the ligamentum flavum.…”

Modified Interlaminar Endoscopic Lumbar Discectomy for Highly Upmigrated Disc Herniation: A Proctorship Description of the Technique via Translaminar Route

“…The cases with the fragments in the shoulder of the upper nerve root are better managed with an endoscopic transpedicular approach. 26 Xin et al 27 reported a series of 11 highly migrated LDH operated by a modified translaminar osseous channel assisted percutaneous endoscopic technique. All the LDH were sequestered and highly migrated but the direction of migration was not mentioned and they had 9 cases with excellent, 1 case each with good and fair outcome on the Macnabs criteria.…”