EARLY RESULTS OF TRANSFORAMINAL PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY UNDER LOCAL AND SEDOANALGESIA

Objective: After the first description of percutaneous posterolateral nucleotomy by Kambin in 1973, transforaminal percutaneous endoscopic lumbar discectomy (PELD) was developed and its use has been increasing in recent years. To describe the surgical technique and anesthesia protocol of transforaminal PELD under local and sedoanelgesia in patients with lumbar disc herniations (LDH) and to report our early results. Materials and Methods: We included 20 patients who underwent transforaminal PELD under local and sedoanalgesia within a period of two months between January 2019 and February 2019 and who had at least a three-month postoperative follow-up period. LDH was at L4-5 in 28.6% of the patients, at L5-S1 in 33.3% of the patients, at L3-4 in 14.3% of the patients, both at L4-L5 and L5-S1 levels in 14.3% of the patients, and at L2-L3 in 1 patient. Results: The mean preoperative Visual anolog scale (VAS) score was 9.4±1.8 (range=8-10) and the mean early postoperative VAS score was 1.85±1.2 (range=0-6). During follow-up, recurrent LDH was seen in 2 patients. One patient developed epidural fibrosis. The mean VAS scores were found to be 1.8±1.69 at the third month follow-up. There was a significant difference between the preoperative VAS scores and the VAS scores in the early postoperative and third month follow-up (p

Kaynakça

1. Akagi S, Saito T, Kato I, Sasai K, Ogawa R. Clinical and pathologic characteristics of lumbar disk herniation in the elderly. Orthopedics 2000;23:445-8.

2. An HS, Vaccaro A, Simeone FA, Balderston RA, O’Neill D. Herniated lumbar disc in patients over the age of fifty. J Spinal Disord 1990;3:143-6.

3. Brock M, Patt S, Mayer HM. The form and structure of the extruded disc. Spine 1992;17:1457-61.

4. Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 2008;15:E508-15.

5. Choi G, Prada N, Modi HN, Vasavada NB, Kim JS, Lee SH. Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L4- L5 disc through an L5-S1 interlaminar approach: a technical note. Minim Invasive Neurosurg 2010;53:147-52.

6. Cooper RG, Mitchell WS, Illingworth KJ, Forbes WS, Gillespie JE, Jayson MI. The role of epidural fibrosis and defective fibrinolysis in the persistence of postlaminectomy back pain. Spine 1991;16:1044-8.

7. Ebeling U, Reulen HJ. Are there typical localisations of lumbar disc herniations? A prospective study. Acta Neurochir (Wien) 1992;117:143-8.

8. Eun SS, Lee SH, Erken HY. Transforaminal Percutaneous Endoscopic Lumbar Diskectomy for Downmigrated Disk Herniations: Lever-Up, Rotate, and Tilt Technique. J Neurol Surg A Cent Eur Neurosurg 2018;79:163-8.

9. Eun SS, Lee SH, Liu WC, Erken HY. A novel preoperative trajectory evaluation method for L5-S1 transforaminal percutaneous endoscopic lumbar discectomy. Spine J 2018;18:1286-91.

10. Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien) 1995;133:107-11.

11. Goel VK, Nishiyama K, Weinstein JN, Liu YK. Mechanical properties of lumbar spinal motion segments as affected by partial disc removal. Spine 1986; 11:1008-12.

12. Hijikata S, Yamagishi M, Nakayma T. Percutaneous discectomy: a new treatment method for lumbar disc herniation. J Tokyo Den-ryoku Hosp 1975;5:39-44.

13. Kambin P. Posterolateral percutaneous lumbar discectomy and decompression. In: Kambin P, (Ed.). Arthroscopic Microdiscectomy: Minimal Intervention in Spinal Surgery. Urban & Schwarzenberg, Baltimore, MD 1991;pp:67-100.

14. Kambin P, Casey K, O’Brien E, Zhou L. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg 1996;84:462-7.

15. Kambin P, Cohen LF, Brooks M, Schaffer JL. Development of degenerative spondylosis of the lumbar spine after partial discectomy. Comparison of laminotomy, discectomy, and posterolateral discectomy. Spine 1995;20:599-607.

16. Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine: a preliminary report. Clin Ortho 1983;174:127-32.

17. Kambin P, O’Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 1998;347:150-67.

18. Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res 1986;207:37-43.

19. Kuzeyli K, Cakir E, Usul H, Baykal S, Yazar U, Karaarslan G, et al. Posterior epidural migration of lumbar disc fragments: report of three cases. Spine 2003;28:E64-E7.

20. Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J 2007;16:431-7.

21. Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine 2006;31:E285-E90.

22. Lee SH, Kang HS, Choi G, Kong BJ, Ahn Y, Kim JS, et al. Foraminoplastic ventral epidural approach for removal of extruded herniated fragment at the L5-S1 level. Neurol Med Chir (Tokyo) 2010;50:1074-8.

23. Lee SH, Kang HS. Percutaneous endoscopic laser annuloplasty for discogenic low back pain. World Neurosurg 2010;73:198-206; discussion e33.

24. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 1971;53:891-903.

25. Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993;78:216-25.

26. Mayer HM, Brock M. Percutaneous endoscopic lumbar discectomy (PELD). Neurosurg Rev 1993;16:115-20.

27. McCulloch JA, Young PH. Microsurgery for lumbar disc herniation. In: McCulloch JA, Young PH, (Eds.). Essentials of Spinal Microsurgery. Lippincott-Raven, Philadelphia 1998;pp:329-82.

28. Mirkovic SR, Schwartz DG, Glazier KD. Anatomic considerations in lumbar posterolateral percutaneous procedures. Spine 1995;20:1965-71.

29. Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine 1996;21:1556-63.

30. Mochida J, Toh E, Nomura T, Nishimura K. Risks and benefits of percutaneous nucleotomy for lumbar disc herniation. A 10-year longitudinal study. J Bone Joint Surg Br 2001;83:501-5.

31. Natarajan RN, Andersson GB, Patwardhan AG, Andriacchi TP. Study on effect of graded facetectomy on change in lumbar motion segment torsional flexibility using three-dimensional continuum contact representation for facet joints. J Biomech Eng 1999;121:215-21.

32. Osman SG, Nibu K, Panjabi MM, Marsolais EB, Chaudhary R. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine 1997;22:1690-5.

33. Parke WW. The significance of venous return impairment in ischemic radiculopathy and myelopathy. Orthop Clin North Am 1991;22:213-21.

34. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 1996;38:855-61.

35. Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 2005;30:2570-8.

36. Schaffer JL, Kambin P. Percutaneous posterolateral lumbar discectomy and decompression with a 6.9-millimeter cannula. Analysis of operative failures and complications. J Bone Joint Surg Am 1991;73:822-31.

37. Schellinger D, Manz HJ, Vidic B, Patronas NJ, Deveikis JP, Muraki AS, et al. Disk fragment migration. Radiology 1990;175:831-6.

38. Weber BR, Grob D, Dvorak J, Müntener M. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 1997;22:1765-72.

39. Yeung AT. Minimally invasive disc surgery with the Yeung endoscopic spine system (YESS). Surg Technol Int 2000;8: 267-277.

40. Yeung AT. The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med 2000;67:327-32.

41. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002;27:722-31.

42. Zander T, Rohlmann A, Klockner C, Bergmann G. Influence of graded facetectomy and laminectomy on spinal biomechanics. Eur Spine J 2003;12:427-34.

Kaynak Göster

  • ISSN: 2147-5903
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1989
  • Yayıncı: Galenos Yayınevi

2.7b 1.9b