Percutaneous Endoscopic Discectomy for Far Lateral Lumbar Disc Herniations: Prospective Study and Outcome of 66 Patients

Sasani, Mehdi; Özer, Ali Fahir; Öktenoğlu, Tunç; Canbulat, Nazan; Sarıoğlu, Ayşe

doi:10.1055/s-2007-984383

Cited by 74 publications

(52 citation statements)

References 14 publications

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“…The sequence of surgery was identical to the general transforaminal endoscopic procedure 1,21,22,25) . Prior to the procedure, using indigo-carmine dye, evocative chromodiskography 18,22) was performed.…”

Section: Surgical Techniquementioning

confidence: 99%

Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram

Chae

Lee

et al. 2009

J Korean Neurosurg Soc

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Objective : The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations. Methods : The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach. Results : The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases. Conclusion : In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.

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Section: Surgical Techniquementioning

confidence: 99%

Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram

Chae

Lee

et al. 2009

J Korean Neurosurg Soc

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“…2,4,5,7,8,10,13,15,17,18,20,21,24,25 Combining the advantages of the often used paramedian muscle-splitting approach and the endoscopic far-lateral approach, Greiner-Perth and coworkers described a minimally invasive variant of the paraspinal muscle-splitting approach and introduced a tubular working channel. 9 The technique was called the microscopeassisted technique.…”

Section: Discussionmentioning

confidence: 99%

“…In skilled hands, the endoscopic technique is very elegant and efficient. 2,19,21 The surgical trauma is minimal, and even intraforaminal disc material can be removed. Furthermore, patients can be mobilized immediately.…”

Section: Discussionmentioning

confidence: 99%

“…First, the 2D technique and the exceptional endoscopic view implicate a shallow learning curve. 21 A demanding technique and a shallow learning curve for the treatment of a rare disease (ELDH comprises 7%-12% of all disc herniations) allow for good clinical results only in experienced hands and in a few specially trained centers that have a high frequency of suitable patients. The endoscopic technique is not a problem in skilled hands, but the difficulty is in reaching this expert level.…”

Section: Discussionmentioning

confidence: 99%

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Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations

Eicker

Rhee²,

Steiger

et al. 2013

FOC

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Object Approaches to treating extraforaminal lumbar disc herniations can be challenging due to the unique anatomy and the need to prevent spinal instability. Numerous approaches, including conventional midline, paramedian, minimally invasive, and full endoscopic approaches, have been described. The purposes of this study were to point out the outcome and clinical advantages of a transtubular microsurgical approach and to describe and illustrate this technique. Methods Between 2009 and 2012, a series of 51 patients underwent a minimally invasive dilative transtubular microsurgical approach for the treatment of extraforaminal lumbar disc herniations. All patients were clinically evaluated using the visual analog scale (VAS) and Oswestry Disability Index preoperatively and 6 months postoperatively. Results Both pain scores and functional status showed significant improvement after surgery (p < 0.001): radicular pain decreased from VAS score of 7.9 to one of 1.3, lower back pain from VAS score of 2.4 to 1.4, and the Oswestry Disability Index from 42.0 to 12.3. Subgroup analyses revealed no differences in outcome regarding obesity or timing of surgery (early vs late intervention). Highly significant was the correlation between preoperative radicular pain activity and timing of surgical intervention (p < 0.001). Conclusions The dilative transtubular microsurgical approach combines the advantages of the conventional open muscle-splitting approach and the endoscopic approach. The technique is easy to use with a steep learning curve. Less muscle trauma and the absence of bony resection prevent facet pain and instability, thereby contributing to a rapid recovery. Patients in this series improved excellently in the short-term follow-up.

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“…It is possible to see the nerve success rate of TED is directly proportional to the selection of suitable cases. Percutaneous arthroscopic discectomy with rigid endoscopic optic is a method that should be considered particularly for extraforaminal or far lateral lumbar disc herniations (26,27). Lumbar tomography will be very useful for the surgical strategy if advanced bone deformity and degeneration are seen on lumbar MRI in radiology studies.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal approach in lumbar disc pathologies: “transforaminal microdiscectomy (tfmd) technique”

Dalbayrak¹,

Yaman²,

Yılmaz³

et al. 2013

Turkish Neurosurgery

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AIm:The endoscopic foraminal approach in foraminal, lateral and far-lateral disc hernias, is a contemporary minimal invasive approach. This study was performed to show that the approach is possible with using the microscope without an endoscope, and even intervention on the discs within the spinal canal is possible by having access through the foramen. mATErIAl and mEThOds: Forty-two cases with disc hernias in the medial of the pedicle were included in this study. Surgeries were performed with the transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin's triangle. The foramen was enlarged and the spinal canal was entered. rEsulTs:The procedure took 65 minutes on average, and the mean bleeding amount was about 100 ml. Patients were mobilized within the same day postoperatively. No permenant complications were seen. Follow-up periods ranged between 5 and 84 months and the mean followup period was 30.2 months. CONClusION:Transforaminal microdiscectomy is a method that can be performed in any clinic with standard neurosurgical instruments. It does not require additional equipment or a high amount of investment. Application of transforaminal inter-body fusion is possible when required. KEywOrds

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Percutaneous Endoscopic Discectomy for Far Lateral Lumbar Disc Herniations: Prospective Study and Outcome of 66 Patients

Cited by 74 publications

References 14 publications

Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram

Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram

Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations

Transforaminal approach in lumbar disc pathologies: “transforaminal microdiscectomy (tfmd) technique”

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