Full-endoscopic transpedicular discectomy (FETD) for lumbar herniations: Case report and review of the literature

Giordan, Enrico; Verme, Jacopo Del; Coluzzi, Flaminia; Canova, Giuseppe; Billeci, Domenico

doi:10.1016/j.ijscr.2020.05.085

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…Uniyal et al [6] first described transpedicular approach for high down migrated disc herniation. Similarly, various spine surgeons tried transpedicular approach with significant success rate [7][8][9]. Kim et al [10] narrated 3 routes of transforaminal approach to approach the high migrated HNP.…”

Section: Discussionmentioning

confidence: 99%

Full Endoscopic Translaminar Approach Using 7 mm Working Endoscope for High Up Migrated Disc Herniation with Severely Collapsed Disc Space: Technical Note

Raorane¹,

Kim²,

doshi³

et al. 2023

J Minim Invasive Spine Surg Tech

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The clear indication for the transforaminal approach is simple or low migrated lumbar disc herniation (LDH). The incidence of migration of the disc fragment in LDH varies from 35% to 72%. The high up migrated disc herniation into MacNab’s hidden zone remains technical challenge. We provide a technical note of seldomly performed full endoscopic translaminar approach with its potential indications. A 52 years male patient presented with low back pain with left lower limb radiculopathy for 2 months. Visual analogue scale for back and leg was 2 and 8, respectively. MRI examination revealed high up migrated disc herniation with collapsed disc space at L4-5. Dynamic radiograph was not showing any instability. Based on the preoperative surgical planning working cannula was docked over left L4 lamina perpendicular to horizontal plane. With the help of 3.5 mm endoscopic burr translaminar keyhole was drilled in a concentric manner. The distance between lateral margin of pars and keyhole was intermediately inspected for preservation of adequate bone in pars interarticularis. Though the translaminar key hole subluxated tip of SAP, up-migrated disc fragment was removed. The VAS score of leg reduced significantly from 8 to 2 in immediate postoperative period. At the end of 6 months follow up period patients leg symptoms completely improved with minimal back pain. We measured the width of remaining pars postoperatively and found to be 5 mm. The full endoscopic translaminar approach is valid alternative approach for the high up migrated HNP.

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Section: Discussionmentioning

confidence: 99%

Full Endoscopic Translaminar Approach Using 7 mm Working Endoscope for High Up Migrated Disc Herniation with Severely Collapsed Disc Space: Technical Note

Raorane¹,

Kim²,

doshi³

et al. 2023

J Minim Invasive Spine Surg Tech

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“…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 . Jiang et al 15 included 35 patients in a retroperspective study showing good clinical results and confirmed bony healing of the transpedicular hole with a CT scan six months postoperatively for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Jiang et al 15 included 35 patients in a retroperspective study showing good clinical results and confirmed bony healing of the transpedicular hole with a CT scan six months postoperatively for all patients. None of the abovementioned publications 11–15,29 described severe complications, including a pedicle fracture. However, according to our findings, a transpedicular approach weakens the resistance to axial compression of the neural arch on average by 26% and up to 63%.…”

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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“…This technique was later duplicated by some other researchers and similar experiments were conducted, but most of them were limited to case reports. The technique was not elaborated in detail, and long-term clinical follow-up was lacking, especially for the outcome of bony defects caused by creating the approach, which led to a lack of clarity ( 13 – 15 ). In a study in 2007, our team identified that for a highly migrated disc herniation, transforaminal, interlaminar, and transpedicular approaches can all be good at removing the protruding and displaced nucleus pulposus, of which the transpedicular approach is more direct, but requires good technical and equipment support ( 16 ).…”

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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Full-endoscopic transpedicular discectomy (FETD) for lumbar herniations: Case report and review of the literature

Cited by 9 publications

References 8 publications

Full Endoscopic Translaminar Approach Using 7 mm Working Endoscope for High Up Migrated Disc Herniation with Severely Collapsed Disc Space: Technical Note

Full Endoscopic Translaminar Approach Using 7 mm Working Endoscope for High Up Migrated Disc Herniation with Severely Collapsed Disc Space: Technical Note

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

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