Percutaneous endoscopic lumbar discectomy via adjacent interlaminar space for highly down-migrated lumbar disc herniation: a technical report

Abstract

The treatment of highly migrated lumbar disc herniation (LDH) is a challenge for percutaneous endoscopic lumbar discectomy (PELD). The purpose of this study was to determine the feasibility and efficacy of PELD for highly migrated LDH via the adjacent interlaminar space. We performed PELD via the adjacent interlaminar space in three patients with radiculopathy caused by highly migrated LDH using a full-endoscopic system (diameter of working channel: 4.1 mm, outer diameter: 6.9 mm). One case had a large interlaminar bone window that did not require enlargement. Enlargement of the bone window in other cases was performed with a 3.5-mm diameter high-speed drill. After the operation, we confirmed pain relief and evacuation of migrated LDH on magnetic resonance imaging in all patients. The mean operative time was 75.3 min, and no complication was observed. PELD via the adjacent interlaminar space is an appropriate operative approach for highly down-migrated LDH. Minimal laminectomy using a high-speed drill is conductive to this approach.

Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up

“…Many spine surgeons have developed novel techniques for managing high-grade migrated lumbar disc herniation by using FELD, including expanding the entry point of the transforaminal endoscopic lumbar discectomy (TELD) approach by using the foraminoplastic technique [ 4 , 9 – 11 ], the transfacet process and pedicle-complex approach [ 12 ], two-level TELD [ 8 ], contralateral TELD [ 13 ], the suprapedicular approach [ 14 ], and the transpedicular approach [ 15 , 16 ]. Alternatively, surgeons may opt to use a technique involving the posterior route, including the translaminar approach [ 17 , 18 ], the interlaminar endoscopic lumbar discectomy (IELD) approach [ 19 , 20 ], or adjacent IELD [ 21 ], which are similar to open surgery. Although improvements in equipment and techniques have resulted in better outcomes in FELD than in conventional open surgery, the management of high-grade migrated discs remains a challenge.…”

Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

“…The selective fragmentectomy was performed for both ILA and TFA and normal nucleus pulposus was preserved [ 12 ]. The detailed operative procedures have been previously described [ 13 , 14 , 15 ].…”

Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

“…Indications of PELD have been limited to nonmigrated or low-migrated lumbar disc herniations due to anatomical barriers that challenge its application for highly migrated disc herniations [7, 13, 14]. However, with the development of techniques and instruments, such as wide application of reamer kits, high-speed endoscopic drills, and flexible curved forceps in clinical practice, the indications of PELD have been extended to highly migrated disc herniations [15, 16, 17, 18, 19, 20]. Furthermore, in order to improve clinical outcomes and reduce the incidence of complications, various modified PELD techniques have been introduced, e.g., the foraminoplasty and interlaminar approaches [13, 21, 22].…”