Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches
| Autor: | Won-Chul Choi, Seungcheol Lee, Song-Woo Shin, Sang-Ho Lee, Gun Choi, Won Joong Kim, Seok-Kang Kim |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
medicine.medical_specialty Percutaneous Adolescent Endoscope Lumbar vertebrae Humans Medicine Diskectomy Percutaneous Orthopedics and Sports Medicine Ideas and Technical Innovations Diskectomy Aged Lumbar Vertebrae medicine.diagnostic_test business.industry Endoscopy Magnetic resonance imaging Middle Aged Magnetic Resonance Imaging Epidural space Surgery Treatment Outcome medicine.anatomical_structure Intervertebral Disc Displacement Radiology business |
| Zdroj: | European Spine Journal. 16:431-437 |
| ISSN: | 1432-0932 0940-6719 |
| DOI: | 10.1007/s00586-006-0219-4 |
| Popis: | Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with "half-and-half" technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with "epiduroscopic" technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9-20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 +/- 1.7 preoperatively to 2.6 +/- 1.8 at the final follow-up (P0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations. |
| Databáze: | OpenAIRE |
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