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. 2009 Oct;46(4):312-6.
doi: 10.3340/jkns.2009.46.4.312. Epub 2009 Oct 31.

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

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Free PMC article

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

Ki Hwan Chae et al. J Korean Neurosurg Soc. .
Free PMC article

Abstract

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.

Keywords: Intervertebral disc herniation; Percutaneous discectomy; Posterolateal approach.

Figures

Fig. 1
Fig. 1
High grade canal compromised type. Pre-operative magnetic resonance (MR) images show herniated disc material encroaching the canal by more than one-half (A and B). Discogram with computed tomogtaphy image show non-contained disc herniation (C). Post-MR image showing disc materials removed successfully and the dural sac re-expanded (D and E).
Fig. 2
Fig. 2
High grade non-contained foraminal disc. Pre-operative magnetic resonance (MR) images shows right huge non-contained L5-S1 foraminal disc (A, B and C). Preoperative 3D computed tomography image with discogram shows disc material herniated through the foramen between the right L5 and S1 pedicle (D and E) Post-operative MR images shows foraminal disc material extracted completely (F, G and H).
Fig. 3
Fig. 3
Suprapedicular approach. The epidural space is exposed by clearing around the pedicle, and the lesional disc can be removed through this point. A : Intra-operative view. B : Schematic drawing. The red round area indicates the intra-operative view (A), Red arrow : Pathway of suprapedicular approach.

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