Full-endoscopic interlaminar approach for L5-S1 extruded and migrated central hernias. Case series study
DOI:
https://doi.org/10.1016/j.rccot.2020.04.010Keywords:
lumbar pain, spine, endoscopy, interlaminar, minimally invasive, surgeryAbstract
Background: Endoscopic spine surgery has shown to be an option for disc hernias and foraminal stenosis. Although the most used approach is transforaminal, this approach is limited in cases of extruded and migrated central hernias. The full-endoscopic interlaminar approach has led to the treatment of the lumbar pain secondary to extruded and migrated central herniated discs at L5 - S1, and is an alternative for resolving technical difficulties related to the transforaminal approach at this level. The aim of this article is to report the results obtained with a fullendoscopic interlaminar approach for the treatment of central extruded and migrated herniated discs, with a two-year follow-up.
Methods: A descriptive observational retrospective study was conducted using the records of patients who had a radiculopathy secondary to a central herniated disc at level L5 - S1, and who were treated with a full-endoscopic interlaminar approach. An evaluation was made of the pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry ODI criteria, and MacNab criteria.
Results: A total of 99 procedures were performed in the same number of patients between 2008 and 2015. All were treated with a standard surgical technique and under local anaesthesia and sedation. The visual analogue score showed a reduction of 5.81 points. The ODI was down 45.63%, and 88% of the patients were completely satisfied with the treatment.
Discussion: The results lead us to consider that full-endoscopic interlaminar fragmentectomy under local anaesthesia and sedation is a safe, accurate, and effective procedure for the treatment of radiculopathy related to L5 - S1 extruded and migrated central hernia. Use of local anaesthesia and sedation as the only analgesic alternative may not be the best option in this type of technique.
Evidence Level: IV
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References
Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Kazakos K. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation. Int J Spine Surg. 2017;28, 11:28. https://doi.org/10.14444/4028. eCollection 2017.
Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;4:CD010328, https://doi.org/10.1002/14651858.CD010328.pub2
Xuan Wang, Benny Borgman, Simona Vertuani, Jonas, Nilsson. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017;17:446. https://doi.org/10.1186/s12913-017-2398-6
Ruetten S, Komp M, Merk H, Godolias MDG. Use of newly developed instruments and endoscopes: fullendoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6:521-30. https://doi.org/10.3171/spi.2007.6.6.2
Osorio E, Ramírez JF, Rugeles JG, Alonso GO. Endoscopy and thermodiscoplasty: a minimally invasive surgical treatment for lumbar pain. En: Ramina R, editor. Samii's Essentials in Neurosurgery. Springer-Verlag Berlin Heidelberg; 2014. p. 103-15. ISBN: 978-3-540-49249-8. https://doi.org/10.1007/978-3-642-54115-5_10
Osorio E, Ramírez JF, Rugeles JG, Alonso GO. Endoscopic Spine Surgery as Treatment for Lumbar Disc Herniation and Foraminal Stenosis. En: Ramani PS, editor. Textbook of Surgical Management of Lumbar Disc Herniation. London: Jaypee Brothers; 2014. p. 372.
Choi G, Lee SH, Raiturker PP, Lee S, Chae YS. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery. 2006;58 1 Suppl. ONS59-68; discussion ONS59-68. https://doi.org/10.1227/01.NEU.0000192713.95921.4A
Ruetten S, Komp M, Merk H, Godolias MDG. Full-Endoscopic Interlaminar and Transforaminal Lumbar Discectomy versus Conventional Microsurgical Technique. A Prospective, Randomized. Controlled Study. Spine. 2008;33:931-9. https://doi.org/10.1097/BRS.0b013e31816c8af7
Tu Z, Li YW, Wang B, Lu G, Li L, Kuang L, Dai Y. Clinical Outcome of Full-endoscopic Interlaminar Discectomy for Singlelevel Lumbar Disc Herniation: A Minimum of 5-year Follow-up. Pain Physician. 2017;20:E425-30. https://doi.org/10.36076/ppj.2017.E430
Choi KC, Kim JS, Ryu KS, Kang BU, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician. 2013;16:547-56. https://doi.org/10.36076/ppj.2013/16/547
Wang B, Lü G, Liu W, Cheng I, Patel AA. Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: the causes and prophylaxis of conversion to open. Arch Orthop Trauma Surg. 2012;132:1531-8, https://doi.org/10.1007/s00402-012-1581-9, Epub 2012 Jul 5.
Lee JS, Kim HS, Jang JS, Jang IT. Structural Preservation Percutaneous Endoscopic Lumbar Interlaminar Discectomy for L5-S1 Herniated Nucleus Pulposus. Biomed Res Int. 2016;2016:6250247. Epub 2016 Oct 10. https://doi.org/10.1155/2016/6250247
Xie TH, Zeng JC, Li ZH, Wang L, Nie HF, Jiang HS, Song YM, Kong QQ. Complications of Lumbar Disc Herniation Following Fullendoscopic Interlaminar Lumbar Discectomy: A Large, SingleCenter. Retrospective Study. Pain Physician. 2017;20:E379-87. https://doi.org/10.36076/ppj.2017.E287
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