General Session: Endoscopic Surgery
Presented by: N. Adsul
N. Adsul(1), H.S. Kim(1), S.H. Choi(1), K.J. Kim(1), J.H. Kim(1), S.K. Chung(1), J.H. Choi(1), J.S. Jang(1), I.T. Jang(2), S.H. Oh(3), Jae Eun Park, Sol Lee
(1) Nanoori Suwon Hospital, Neurosurgery, Suwon, Korea, Republic of
(2) Nanoori Hospital, Neurosurgery, Seoul, Korea, Republic of
(3) Nanoori Incheon Hospital, Neurosurgery, Incheon, Korea, Republic of
Purpose: Percutaneous endoscopic lumbar discectomy is a good treatment modality in the lumbar disc herniation. However, when a patient complains of bilateral lower limb radicular pain with severe disc protrusion at the L5-S1 level, the transforaminal approach is often unable to resolve both lesions due to the anatomical limitations. It is also very difficult to resolve both lesions through an ipsilateral direction using the percutaneous interlaminar approach. Here, we report the surgical technique and clinical results after using a ventral dural approach of the percutaneous endoscopic interlaminar lumbar discectomy for L5-S1 herniated nucleus pulposus (HNP) in patients complaining of bilateral radiculopathy due to a severe bilateral disc protrusion.
Objective: Twenty-seven patients with severe L5-S1 HNP complaining of back pain and bilateral lower limb radiculopathy were included in this study. In all patients unilateral ventral dural approach for percutaneous endoscopic Interlaminar lumbar discectomy of bilateral lesions has been performed, and retrospective studies have demonstrated the effectiveness of the treatment.
Methods: The visual analog scale (VAS) and Mac Nab criteria were used for clinical evaluation. All assessments were completed one day before surgery, one week after surgery, 6 months after surgery, and final follow-up after surgery.
Results: The mean preoperative back and leg VAS scores were decreased from 5.67±0.78 and 7.81±0.83 to 2.44±0.58 and 2.26±0.53 at one week, 1.78±0.51 and 1.52±0.58 at 6 months, 1.56±0.70 and 1.67±0.96 at final follow-up after the operation. With respect to the Mac-Nab criteria, 51.85% of results were excellent, 44.44% were good, and 3.70% were fair. There were four cases of recurrence, out of which three improved with conservative treatment and one case was treated with percutaneous endoscopic interlaminar lumbar discectomy.
Conclusion: In this study, we performed a ventral dural approach for percutaneous endoscopic interlaminar lumbar discectomy on patients with L5-S1 HNP complaining of bilateral lower limb radiculopathy due to severe bilateral disc protrusion, and obtained good clinical results. According to the results of this study, percutaneous endoscopic discectomy in patients with L5-S1 HNP associated with bilateral lower limb radiculopathy due to the severely protruded bilateral HNP is a good option to be considered as a minimally invasive surgical approach.