State of the Art: Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

Sairyo, Koichi; Egawa, Hiroshi; Matsuura, Tetsuya; Takahashi, Mitsuhiko; Higashino, Kosaku; Sakai, Toshinori; Suzue, Naoto; Hamada, Daisuke; Goto, Tomohiro; Takata, Yoichiro; Nishisho, Toshihiko; Goda, Yuichiro; Sato, Ryosuke; Tsutsui, Takahiko; Tonogai, Ichiro; Kondo, Kenji; Tezuka, Fumiaki; Mineta, Kazuaki; Sugiura, Kosuke; Takeuchi, Makoto; Dezawa, Akira

doi:10.2152/jmi.61.217

Cited by 79 publications

(77 citation statements)

References 24 publications

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“…However, in this series, there would be contra-indications for the PED TF and FL as follows. 1) Intracanalicular HNP at L5-s with high iliac crest 2) Severely migrated HNP at the hidden zone Surgery is conducted according to the review article of the PED procedure (8). About 8 mm skin incision is required about 8-10 cm laterally from the midline.…”

Section: Introductionmentioning

confidence: 99%

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

et al. 2014

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: The minimally invasive percutaneous endoscopic discectomy (PED) as the postero-lateral approach with the local anesthesia was started in the late 20th century. The procedure only requires 8 mm of skin incision ; thus, it is the least invasive disc surgery presently. The surgery related complications were reviewed in the initial 100 cases from the single surgeon (K.S., first author). Two cases showed exiting nerve irritation, and complained of leg paresthetic pain for 6 to 12 weeks after the surgery (2.0% %). The symptoms got better with medicines. One showed post-surgical epidural hematoma, and required surgical removal of the mass (1.0% %). Two cases complained neck pain during surgery (2.0% %). Surgeons would be aware of the specific complications for the postero-lateral approach of PED procedure. J. Med. Invest. 61 : 264-269, August, 2014

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Section: Introductionmentioning

confidence: 99%

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

et al. 2014

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“…However, this approach basically requires general anesthesia (sometimes epidural anesthesia) because the nerve roots need to be handled and decompressed during surgery. The TF approach, however, can be performed for foraminal stenosis under local anesthesia (14 -17), and this has been of greatest benefit in TF-percutaneous full endoscopic surgery (8,9,31,32). The elderly often have comorbidities (32) rendering them at high risk for general anesthesia, so surgeries that can be done under local anesthesia are preferable in this age group.…”

Section: Discussionmentioning

confidence: 99%

“…With the cadaver in a prone foraminoplasty L5/S L5/S position, an 8 mm skin incision was made posterolaterally on the back 9 cm away from the midline. In accordance with the insideout procedure (8,9,31), the cannula was first inserted into the disc at L4 -5 through the safety triangle. After the selected discectomy (8,9), the cannula was withdrawn to just outside of the disc, where the lateral aspect of the facet joint could be seen endoscopically.…”

Section: Cadaveric Studymentioning

confidence: 99%

A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review

et al. 2017

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: Percutaneous endoscopic surgery for the lumbar spine, which was established in the last decade, requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles ; thus, it is considered to be a minimally invasive technique for spinal surgery. It has been used to perform percutaneous endoscopic discectomy via two main approaches : the TF approach is a posterolateral one through the intervertebral foramen and can be done under local anesthesia ; the IL approach is a more traditional one through the interlaminar space and is difficult to perform under local anesthesia. Recently, these techniques have been applied for lumbar spinal stenosis (LSS), the TF method for foraminal stenosis under local anesthesia, and the IL method for central and lateral recess stenosis under general anesthesia. In this study, using a fresh human cadaver model, we performed simultaneous decompression of the lateral recess and foraminal stenosis at L4-5 using the TF approach. Computed tomography confirmed enlargement of the lateral recess and intervertebral foramen. This technique, which can be performed under local anesthesia, should benefit elderly patients with LSS and poor general condition due to multiple comorbidities. Finally, we introduce the concept of percutaneous transforaminal ventral facetectomy using a spinal percutaneous endoscope. J. Med. Invest. 64 : 1-6, February, 2017Keywords : Percutaneous endoscopic surgery, lumbar spinal stenosis, foraminoplasty, ventral facetectomy

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“…Thus surgeons have to be careful not to cause complications, such as exiting nerve root injury, headache, seizure, and organs injury (18). At the local anesthesia and carefully preoperative plans, surgeons can prevent these complications.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report

et al. 2017

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: Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis. However, it has been reported that adjacent level disc degeneration and foraminal stenosis can occur following intervertebral segmental fusion. When this adjacent level pathology becomes symptomatic, additional fusion surgery is often needed. We performed minimally invasive percutaneous full endoscopic lumbar foraminoplasty in an awake and aware 50-year-old woman under local anesthesia. The procedure was successful with no complications. Her radiculopathy, including muscle weakness and leg pain due to impingement of the exiting nerve, improved after the surgery.

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State of the Art: Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

Cited by 79 publications

References 24 publications

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report

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