Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation

Ahn, Yong; Jang, Il‐Tae; Kim, Woo-Kyung

doi:10.1016/j.clineuro.2016.05.016

Cited by 71 publications

(76 citation statements)

References 27 publications

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“…Reoperation to repair the dura sac is a solution. Far-Migrated Disc Herniation may be a risk factor of dura sac tear [17], but the results of PELD for patients with Far-Migrated Disc Herniation shows excellent in several surgeons' reports [18][19][20][21]. Many surgeons like to expose the neural tissues for thorough decompression.…”

Section: Discussionmentioning

confidence: 99%

Complications of Percutaneous Endoscopic Lumbar Discectomy: Experiences and Literature Review

Zhu¹,

Jiang²,

Shang³

et al. 2017

J Spine

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Study design: A retrospective clinical review.Purpose: To explore the type, morbidity, risk factors and treatment strategies of postoperative complication following percutaneous endoscopic lumbar discectomy (PELD) surgery.Overview of literature: PELD became one of the main operation methods for degenerative lumbar diseases, including disc herniation, stenosis and discogenic low back pain. However, complications following PELD surgery are a considerable challenge for spinal surgeons and seldom addressed publicly.Methods: 10120 patients after PELD surgery were studied. These surgeries were finished by 6 surgeons from 3 main minimal invasive spine centers from January 2012 to June 2017. Most of patients are regularly followed up to explore the type, morbidity, risk factors and treatment strategies of postoperative complication following PELD surgery. Results:There are 2 patients died in the perioperative period and 2 patients with permanent impairment of neural function after surgery, which should be the severest complication of PELD surgery. Transient paresthesia, intraoperative bleeding and dura sac tear are the most common complications reported by 6 surgeons. There are 2 suspected cases of postoperative hematoma, several cases of surgical instruments broken during the surgery and 20 cases of infection in 10120 patients, regarded as rare complications of PELD. Recurrence rate of PELD surgery is 4.7% to 6% reported by 3 surgeons. However, recurrence defined as complications of PELD surgery remain controversial. Conclusion:Excellent clinical outcome of large case series after PELD surgery is reported. However, we need to face the limitations and complications of the surgery. The complication rate should be reduced by caring about the treatment, surgical indications strictly selected and the guidance of experienced surgeons.

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Section: Discussionmentioning

confidence: 99%

Complications of Percutaneous Endoscopic Lumbar Discectomy: Experiences and Literature Review

Zhu¹,

Jiang²,

Shang³

et al. 2017

J Spine

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“…With the development of surgical instruments and surgical techniques, the concept of PELD has shifted from indirect intervertebral decompression to epidural targeted decompression, and common types of disc herniation can be treated with PELD [3][4][5][6][7]. However, it is still a challenge for the very high-grade inferiorly migrated disc herniation.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to anatomical barriers, such as pedicle and narrowing of the foraminal space, it is sometimes di cult to insert the working cannula and the surgical scope is limited. Therefore, PELD has not been considered as the best treatment option for very high-grade inferiorly migrated disc herniation [2][3][4] (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Application of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Notch of Inferior Vertebral Pedicle Approach for Very High-grade Inferiorly Migrated Disc Herniation

Chen

Wang

Suo

et al. 2020

Preprint

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Background: To assess the efficacy of the superior notch of inferior vertebral pedicle approach of transforaminal percutaneous endoscopic lumbar discectomy for very high-grade inferiorly migrated disc herniation.Methods: Data on 32 consecutive patients operated with percutaneous endoscopic surgery via the superior notch of inferior vertebral pedicle approach were reviewed. Age, gender, clinical diagnoses, operation time, hospitalization time, a self-administered questionnaire composed of the leg pain visual analogue scale (VAS leg pain) and the Oswestry Disability Index (ODI) had been recorded before operation and 1, 3, 6 and 12 months after operation, respectively. The clinical results were assessed at the final follow-up by using modified Macnab criteria. Complications were recorded during follow-up, and postoperative X-ray, CT and MRI examinations were performed.Results: There were 21 males and 11 females. The mean age of patients was 51.8±10.6 years. MRI findings of patients with disc herniation were L2-3 level in 4 case, L3-4 level in 9 cases and L4-5 level in 19 cases, which were correlated with clinical symptoms. All patients completed a 12-month follow-up assessment after surgery. The mean operative duration was 68.2±12.8 min, and hospitalization time was 3.6±0.8 days. At 12 months follow up the VAS leg pain had improved by 6.3 (P< 0.05) and the ODI by 43.6 points (P< 0.05). Twenty-three cases (71.9%) were rated as excellent, 7 (21.9%) as good, 2 (6.2%) as fair at the final follow-up. On the basis of the modified MacNab criteria, the overall excellent and good rate was 93.8%. Two patients (6.2%) had transient dysesthesia after surgery. Postoperative radiological evaluations showed no signs of instability or recurrence of pathology.Conclusion: Transforaminal percutaneous endoscopic lumbar discectomy via the superior notch of inferior vertebral pedicle approach could be a safe and effective minimally invasive technique for very high-grade inferiorly migrated disc herniation. This technique warrants further study and clinical application.

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“…Yeung and Gore suggested that HNP in the hidden zone can be safely accessed by transforaminal PELD . Ahn et al reported a standardized technique of transforaminal PELD for very high‐grade migrated disc herniation; they obtained excellent or good global outcomes in 84.6% of patients, and the rate of symptomatic improvement was 92.3% . However, the manipulation of transforaminal PELD is not easy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic transpedicle approach for herniated nucleus pulposus in the lumbar hidden zone

Wang¹,

Pan²,

Hu³

et al. 2017

Asian J Endoscop Surgery

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Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation

Abstract: Transforaminal PELD can be effective for very high-grade migrated lumbar disc herniation, and a standardized technique may provide a reliable and reproducible result.

Cited by 71 publications

References 27 publications

Complications of Percutaneous Endoscopic Lumbar Discectomy: Experiences and Literature Review

Complications of Percutaneous Endoscopic Lumbar Discectomy: Experiences and Literature Review

Clinical Application of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Notch of Inferior Vertebral Pedicle Approach for Very High-grade Inferiorly Migrated Disc Herniation

Percutaneous endoscopic transpedicle approach for herniated nucleus pulposus in the lumbar hidden zone

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