A novel vertebral trench technique (VTT) involving transforaminal endoscopic lumbar foraminotomy (TELF) for very highly up-migrated lumbar disc herniation above L5

Abstract

Background Percutaneous endoscopic lumbar discectomy (PELD) has become popular for the treatment of symptomatic lumbar disc herniation (LDH). The very highly up-migrated lumbar disc herniation (VHUM-LDH) is difficult to remove under PELD. The purpose of this research is to investigate the feasibility, clinical efficacy and operative nuances of a novel VTT involving TELF for this type of herniation. Methods Eleven patients with very highly up-migrated LDH who underwent VTT involving TELF discectomy from May 2016 to May 2019 were included in this study. The operative time, length of hospital stay, and postoperative complications were recorded. Pre-and postoperative radiologic findings were investigated. All the patients were followed more than 1 year. The visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores and modified MacNab criteria were used to assess surgical efficacy. Results All the 11 patients underwent successful surgery. We compared the VAS, ODI, and JOA scores before and after surgery. The differences were statistically significant (P < 0.05). According to the modified MacNab criteria, 10 patients were assessed as “excellent”, 1 patient was assessed as “good” at the last follow up. Conclusion The novel VTT involving TELF discectomy is a supplement to the traditional PELD. This technique enables the endoscope with working cannula to get closer the sequestrated nucleus pulposus without irritating the exiting nerve root, and facilitates the nucleus pulposus be removed successfully under direct visualization. The VTT involving TELF discectomy can be a safe, effective and feasible surgical procedure for the treatment of LDH with very highly up-migrated.

Clinical efficacy of posterior endoscopic cervical modified trench technique in the treatment of cervical spondylotic myelopathy: A retrospective study

“…It is a safe, effective, and feasible surgical procedure for the treatment of CSM with very highly up-migrated nucleus pulposus. [20] According to our findings, the drill may still block intraoperative vision during the central spinal canal decompression procedure. It is also difficult to determine the decompression range (especially the central to the contralateral range), the position of the bleeding point, and the subsidence influence of the dura mater from an endoscopic perspective.…”

Comparison of bone reamer and trephine for foraminoplasty in percutaneous endoscopic lumbar discectomy based on 3D slicer and Digimizer software

“…The bone reamer and the trephine, as commonly used foraminoplasty instruments in current clinical practice [13] , have their own advantages and disadvantages. The bone reamer restored more bone mass [14] ,but were low-e ciency and led to more X-ray exposure. The trephine was e cient [15] , while the degree of bone resection was higher and might lead to lumbar instability [16] .…”

Interventional Therapy and Surgical Management of Lumbar Disc Herniation in Spine Surgery: A Narrative Review

“…Although percutaneous endoscopic lumbar discectomies are a popular approach for symptomatic LDH, very highly up migrated lumbar disc herniations (VHUM-LDH) are difficult to treat via traditional approaches; this is due to anatomical barriers that often hide the sequestered nucleus pulposus from being viewed endoscopically. 44 Therefore, newer studies have proposed the use of a novel transforaminal endoscopic lumbar foraminotomy (TELF)(Figure 3). A study by Yu et al 44 assessed the efficacy of TELF on 11 patients with VHUM-LDH and found significant improvements to mean VAS, ODI, and JOA scores.…”

“…44 Therefore, newer studies have proposed the use of a novel transforaminal endoscopic lumbar foraminotomy (TELF)(Figure 3). A study by Yu et al 44 assessed the efficacy of TELF on 11 patients with VHUM-LDH and found significant improvements to mean VAS, ODI, and JOA scores. Additionally, the MacNab criteria for pain relief demonstrated 10 patients as "excellent" with one patient being "good".…”