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Subject Area

Degenerative, Minimally invasive procedures

Document Type

Original Study

Abstract

Background Data: Since the initial idea by Kambin and Gellman in 1973 of percutaneous posterolateral lumbar disc decompression, the evolution of minimally invasive interventions in disc herniation has been widely growing. The advancements in optics and surgical instruments allowed surgeons to perform true minimally invasive procedures in a wide range of spine pathologies. In addition, transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has been widely utilized in various degenerative spine pathologies, due to the presence of high-speed drills, flexible forceps, scissors, curettes, and probes to manage pathologies such as disc herniation or canal stenosis.

Study Design: Prospective clinical case study.

Purpose: The primary objective of this study is to assess the feasibility of migrated lumbar disc excision by TPELD, and the secondary objective is to report any technical difficulty or complications related to the technique.

Patients and Methods: Between January 2018 and January 2020, 20 patients who underwent TPELD for radiologically verified caudally migrated lumbar disc prolapse after the failure of conservative therapy were reported. Preoperative and postoperative clinical evaluations were performed for back pain and leg pain by Visual Analog Score (VAS) scoreand for patients’ disability by Oswestry Disability Index. The radiological evaluations pre- and postoperatively were done by lumbosacral MRI complemented by lumbosacral X-ray AP and lateral views. The follow-up visits for the evaluation were immediately after surgery and 6 months and 1 year postoperatively.

Results: A total of 20 cases were involved in this series from January 2018 to January 2020. Nine females and 11 males were included in the study. Postoperatively, the clinical assessment showed improvement in the VAS score of the back pain and leg pain as the mean VAS scores for back pain and leg pain immediately were 4.55 ± 1.70 and 2.4 ± 0.68, respectively. At the 6-month follow-up, the mean VAS scores for back pain, leg pain, and ODI were 2.15 ± 1.03, 1.35 ± 0.74, and 22.2 ± 6.59, respectively. Finally, after 12 months, the mean VAS scores for back pain, leg pain, and ODI were 1.25 ± 0.71, 0.8 ± 0.52, and 15.85 ± 9.22, respectively.

Conclusion: Minimally invasive TPELD proves to be a valuable utility in managing migrated disc fragments in LDP. However, it is a technically demanding procedure, but with appropriate tools and introducing angles, it will efficiently remove migrated fragments with the preservation of anatomy. Consequently, the stability of the spine will not be harmed. (2021ESJ248)

Keywords

Endoscopic, Lumbar, Disc, Caudal migration, Transforaminal

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