Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation

Jae-Yoon Chung; Jae-Joon Lee

doi:10.4184/jkss.2007.14.3.212

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Chung and Lee: Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation

Original Article

Journal of Korean Spine Surg 2007;14(3):212-219.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.3.212

Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation

Jae-Yoon Chung, M.D., Jae-Joon Lee, M.D.

Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea

Address reprint requests to Jae-Joon Lee, M.D. Department of Orthopedics, Chonnam National University Hospital 8 Hak-dong, Dong-gu, Gwangju, 501-757, Korea Tel: 82-62-227-1640, Fax: 82-62-225-7794, E-mail: sanggunlee@lycos.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Percutaneous endoscopic lumbar discectomy is a widely used procedure. In addition to the surgical techniques, the proper selection of the patients and appropriate approaching portal is important improving the clinical results. The choice of the approaching portal is related to the distance of migration and spinal canal encroachment in addition to the type of herniation type. In addition, it is essential to know the anatomic characteristics at each level of the lumbar spine in addition to the indications of the various approaching portals.

Keywords: Lumbar disc herniation, Percutaneous endoscopic discectomy

REFERENCES

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2). Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine. 1978; 3:175–182.

3). Hijikata S, Yamagishi M, Nakayama T. Percutaneous nucleotomy: a new treatment method for lumbar disc herniation. J Toden Hosp. 1975; 5:5–13.

4). McCulloch JA, Young PH. Essentials of spinal microsurgery. Philadelphia: Lippincott-Raven;1998.

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7). Krugluger J. Transforaminal endoscopic discectomy. (in. Mayer HM, editor. Minimally invasive spine surgery 2nd ed. Springer;p. 315–321. 2005.

8). Krugluger J, Knahr K. Minimal invasive disc surgery: a review. Int Orthop. 2001; 24:303–306.

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10). Rutten S. The full-endoscopic interlaminar approach for lumbar disc herniation. (in. Mayer HM, editor. Minimally invasive spine surgery. 2nd ed.Springer;p. 346–355. 2005.

Figures and Tables%

Fig. 1.

Anatomical characteristics of lumbar spine (A) Relationships of the interpedicular distance, interlaminar space, and laminar overlap at each lumbar segment. (B) Schematic description of laminar overhanging

Fig. 2.

Schematic diagram of the ‘Three-storied anatomical house concept’.

Fig. 3.

Classification of the herniated disc related to the axial plane. A-intraspinal, B-foraminal, C-extraforaminal

Fig. 4.

Considerations to select endoscopic approaching portals.

Fig. 5.

Posterolateral approaching portal (A) uniportal method (B) biportal method

Fig. 6.

Insertion angle of the transforaminal approaching portal not to injure the internal organ.

Fig. 7.

Fluoroscopic image shows the obturator located just above superior wall of pedicle to avoid injury of the exit root.

Fig. 8.

Sagittal (A) and coronal (B) reformatting images of the CT scan show the enough interlaminar space at L5-S1.

Fig. 9.

Transiliac transforaminal approaching portal. (A) Axial T2-weighted MR image shows huge central disc herniaton related with bilateral symptoms. (B) Relationship between the iliac crest and neural foramen of L5-S1. (C, D) Intraoperative fluoroscopic images after insertion of cannula through the transiliac osseous tunnel. The dotted line represented an iliac crest.

Fig. 10.

Diagram of the contralateral transforaminal approach. (A) Contralateral insertion of the obturator and cannula with the low angle than expected. (B) Advance of the cannula not to cross the midline with backward direction of the oblique surface to avoid compression of the central neural structure.

Fig. 11.

Fluoroscopic images after insertion of the endoscope through the contralateral interlaminar space.

Fig. 12.

Intertransverse approaching portal for extraforaminal disc hernation of L5-S1.

Table 1.

Comparison of endoscopic approaches.

	Perineural scar formation	Recurrence	Indication
Posterolateral approach	least*	least*	narrow^†
Transforaminal approach	less	more^†	wide*
Interlaminar approach	moderate	moderate	narrow^†
Translaminar approach	more^†	moderate	narrow^†

^∗ : advantage,

^† : disadvantage

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