Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch’s windows: transpedicular and translaminar sequestrectomy (ridit analysis)

Gizatullin, Sh Kh; Kristosturov, Aleksandr S.; Давыдов, Д. В.; Stanishevskiy, A. V.; Kolobaeva, E G; Dubinin, I P; Ivakhin, A V; Davydov, A N

doi:10.17116/neiro20218506168

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…For this reason, traditional surgery, such as the posterior microsurgical approach, was recommended. Gizatullin et al 28 compared the clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries and noted postoperative back and leg pain regression, neurological recovery, and improvement in the quality of life according to the Oswestry scoring system were more common after transpedicular surgery. Krzok et al 11,12 first described the transpedicular approach to accessing highly downmigrated disc herniations, followed by a limited number of case studies with reported good clinical outcome 13,14,29 .…”

Section: Discussionmentioning

confidence: 99%

The Biomechanics of the Transpedicular Endoscopic Approach

Meisterhans,

Hagel,

Spirig

et al. 2023

Spine

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Study Design. Biomechanical cadaveric study. Objective. The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle was investigated. Summary of Background Data. Clinical studies have repeatedly highlighted the benefits of endoscopic transpedicular decompression for down-migrated lumbar disc herniations. However, the biomechanical effects on pedicle stability have not been studied up to now. Methods. Twenty-four vertebras originating from four fresh-frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the tunneled pedicle on one side, and (2) the native pedicle on the other side. Twelve lumbar vertebrae were assigned to a drill diameter of 6 mm and the other 12 to a diameter of 8 mm. Results. The median ratio of sustained force for the operated side compared to the intact contralateral side is equal to 74% (63–88) for both drill diameters combined. An 8 mm transpedicular approach recorded an axial resistance of 77% (60–88) compared to the intact contralateral side (P=0.002). A 6 mm approach resulted in an axial resistance of 72% (66–84) compared to the intact opposite side (P=0.01). No significant difference between the two different drill diameters was recorded (P=1). For all 3 subgroups (intact, 8 mm, 6 mm) the HU-values and the absolute resistance force showed significant correlations (intact: ρ=0.859; P<0.001; 8 mm: ρ=0.902; P<0.001; 6 mm: ρ=0.835; P<0.001). Conclusion. Transpedicular approach significantly reduces the axial resistance force of the pedicle, which may lead to pedicle fracture. Bone quality correlated positively with the absolute resistance force of the pedicle, whereas the influence of the drill hole diameter plays only a limited role.

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Section: Discussionmentioning

confidence: 99%

The Biomechanics of the Transpedicular Endoscopic Approach

Meisterhans,

Hagel,

Spirig

et al. 2023

Spine

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“…Compared with IMLD, low back pain was significantly reduced with IELD, presumably because it involved less trauma. Gizatullin et al ( 12 ) compared the clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries and noted that the results were similar. However, postoperative back and leg pain regression, neurological recovery, and improvement in the quality of life according to the Oswestry scoring system were more common after transpedicular surgery.…”

Section: Discussionmentioning

confidence: 99%

A Novel Trajectory for a Transpedicular Approach in the Treatment of a Highly Downward-Migrated Lumbar Herniation with a Full Endoscopic Technique

et al. 2022

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BackgroundTo evaluate the clinical outcome of full endoscopic discectomy using a novel trajectory via a transpedicular approach.MethodThirty-five patients were enrolled in this retrospective study between July 2014 and October 2019 in the Beijing Haidian Hospital. All patients were treated with full-endoscopic lumbar discectomy via a transpedicular approach with an oblique trajectory. The imaging parameters, including pedicle height and angle of trajectory, were recorded. The preoperative and postoperative clinical data were collected for statistical analysis.ResultsAll patients underwent successful surgery without severe complications. We compared the visual analogue scale and Oswestry disability index scores before and after surgery. The differences were statistically significant (p < 0.05). According to the modified Macnab criteria, the good-to-excellent rate was 85.7% at the last follow-up. The average angles of trajectory in the sagittal and coronal planes were 34.5° ± 2.9° and 47.1° ± 5.0°, respectively.ConclusionThe new trajectory of the transpedicular approach with a full endoscopic technique for an extremely downward-migrated disc herniation showed excellent results in a small sample study. A precise surgical plan is required, comprising measurements of the pedicle height and angle of the bone tunnel.

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Transpedicular Percutaneous Discectomy for High-Grade Down-Migrated Lumbar Disc Herniation

González-Murillo,

Campos,

Oliveira

et al. 2024

J Minim Invasive Spine Surg Tech

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Objective: The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration.Methods: The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis.Results: The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p<0.05).Conclusion: At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.

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Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch’s windows: transpedicular and translaminar sequestrectomy (ridit analysis)

Cited by 3 publications

References 21 publications

The Biomechanics of the Transpedicular Endoscopic Approach

The Biomechanics of the Transpedicular Endoscopic Approach

A Novel Trajectory for a Transpedicular Approach in the Treatment of a Highly Downward-Migrated Lumbar Herniation with a Full Endoscopic Technique

Transpedicular Percutaneous Discectomy for High-Grade Down-Migrated Lumbar Disc Herniation

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