scholarly journals Quantitative 3D Trajectory Measurement for Percutaneous Endoscopic Lumbar Discectomy

2018 ◽  
Vol 1 (21;1) ◽  
pp. E355-E365
Author(s):  
Xiaoguang Liu
Keyword(s):  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Discectomy ◽  
Minimally Invasive Spinal Surgery ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Bony Structure ◽  
Articular Process ◽  
Volume Proportion ◽  
Endoscopic Lumbar Discectomy ◽  
Virtual Trajectory

Background: Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial. The existing preoperative measuring methods mainly rely on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure and the working channel cannot be precisely evaluated. Objectives: To investigate a 3D method and quantitatively evaluate the trajectory for percutaneous endoscopic lumbar discectomy (PELD). Study Design: Technical note. Setting: Pain medicine center of a university hospital. Methods: Twenty patients suffering from L4/5 disc herniation were enrolled in this study. After reconstructing the preoperative CT images, the virtual trajectory was placed into the intervertebral foramen through gradient-changing angulations in relation to the coronal and transverse planes. The overlapping portion of the virtual trajectory and the lumbar vertebrae was evaluated. In addition, the probability of atypical structure involvement was calculated. Results: As cephalad angulation (CA) increased, the intersection volume of the L4 inferior articular process increased, while the total intersection volume, the intersection volume of the L5 superior articular process, the intersection volume of the facet joint, and the volume proportion of L5 superior articular process intersection in the facet joint all decreased. As coronal plane angulation (CPA) increased, the total intersection volume, the intersection volume of the L4 inferior articular process, and the intersection volume of the facet joint all increased, while the volume proportion of the L5 superior articular process intersection in the facet joint decreased. When CA increased to 15°-20°, there was a high probability of atypical structure involvement, whereas such a probability in the groups of CA 0° (CPA 15°, 20°, and 25°), CA 5° and CA 10° was low. Limitations: Only patients with L4/5 herniation were evaluated in this study. Conclusions: In terms of the regularity, the ideal angulation for L4/L5 PELD is CPA 5°-10° and CA 5°-10°, which can lead to a relatively low level of total damage to the bony structure, minimal damage to the facet joint, and negligible involvement of atypical structures. Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD), transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure obstruction

scholarly journals Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc

2016 ◽  
Vol 19 (2;2) ◽  
pp. E301-E308
Author(s):  
Kyung-Chul Choi
Keyword(s):  
Disc Herniation ◽  
Iliac Crest ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Herniated Disc ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy ◽  
Foraminal Height

Background: Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. Objectives: This study discusses PELD for L5-S1 disc herniation and the appropriate approach according to the height of iliac crest. Study Design: Retrospective evaluation. Methods: 100 consecutive patients underwent PELD via the transforaminal route for L5-S1 disc herniation by a single surgeon. The study was divided into 2 groups: the foraminoplasty group requiring foraminal widening to access the herniated disc and the non-foraminoplasty group treated by conventional posterolateral access. Radiological parameters such as iliac height, the relative position of the iliac crest to the landmarks of the L5-S1 level, iliosacral angle and foraminal height, and disc location were considered. Clinical outcomes were assessed by the Visual Analogue Scale (VAS, 0 – 10) for back and leg pain, the Oswestry Disability Index (ODI, 0 – 100%), and the modified MacNab criteria. Results: The overall VAS scores for back and leg pain decreased from 6.0 to 2.3 and from 7.5 to 1.7. The mean ODI (%) improved from 54.0 to 11.6. Using modified MacNab criteria, a good outcome was 92%. Foraminoplasty was required in 19 patients. Iliac crest height was significantly higher in the foraminoplasty group than the non-foraminoplasty group (37.7 mm vs 30.1 mm, P < 0.001). In the foraminoplasty group, the iliac crest is above the mid L5 pedicle on lateral radiography in all cases. There were no significant differences in foraminal height, foraminal width, iliosacral angle, or disc height between the 2 groups. In addition, there were no differences in clinical outcome between the 2 groups. Limitations: This study is a retrospective analysis and simplifies the complexity of the L5-S1 level and iliac bone using two-dimensional radiography. Conclusion: In high iliac crest cases where the iliac crest is above the mid L5 pedicle in lateral radiography, foraminoplasty may be considered for transforaminal access of L5-S1 disc herniation. Conventional transforaminal access can be utilized with ease in low iliac crest cases where the iliac crest is below the mid-L5 pedicle. Key words: Percutaneous endoscopic lumbar discectomy, transforaminal, L5-S1, iliac crest, foraminoplasty

scholarly journals A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Manyoung Kim ◽  
Sol Lee ◽  
Hyeun-Sung Kim ◽  
Sangyoon Park ◽  
Sang-Yeup Shim ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Surgical Methods ◽  
Endoscopic Lumbar Discectomy

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.

A Strategy of Percutaneous Endoscopic Lumbar Discectomy for Migrated Disc Herniation

2017 ◽  
Vol 99 ◽  
pp. 259-266 ◽  
Author(s):  
Kyung-Chul Choi ◽  
Dong Chan Lee ◽  
Hyeong-Ki Shim ◽  
Seung-Ho Shin ◽  
Choon-Keun Park
Keyword(s):  
Disc Herniation ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy
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