Original ArticleUsefulness of Percutaneous Endoscopic Lumbar Foraminoplasty for Lumbar Disc Herniation
Introduction
Percutaneous endoscopic lumbar discectomy (PELD) has results comparable to conventional open surgery for herniated discs (HDs). Since the introduction of contemporary endoscopic discectomy by Kambin and Sampson,1 remarkable advances in techniques and instruments have expanded its surgical application for various types of HDs.2, 3, 4, 5 However, the inability to place a working cannula near the disc fragment because of an anatomic barrier can lead to surgical failure and revision open surgery. The superior articular process (SAP) should be the chief obstacle in transforaminal endoscopic access to the dural sac and nerve root in the spinal canal. To overcome this hurdle, foraminoplasty can be considered, allowing the working cannula access near the HD. In this article, we describe our experience using foraminoplasty for HDs and propose the applicable situations for foraminoplasty in PELD for HDs.
Section snippets
Materials and Methods
This study was approved by the institutional review board (2016-W02). A retrospective review of consecutive patients who underwent PELD performed by a single surgeon (K.-C.C.) between December 2014 and December 2015 was performed. Patients were included if they had an HD at L1-2, L2-3, L3-4, L4-5, or L5-S1; were unresponsive to 6 weeks of conservative treatment; and underwent only transforaminal PELD for intracanal disc herniation. Patients were excluded if they had a foraminal and/or
Results
The study included 136 patients; 36 patients (27 men, 9 women; mean age, 42.8 years ± 12.5; age range, 19–62 years) underwent PELD with foraminoplasty. The mean follow-up period was 12.7 months ± 3.7 (range, 6–18 months). The affected lumbar levels included L2-3 (n = 1), L3-4 (n = 3), L4-5 (n = 20), and L5-S1 (n = 12). In the FG, 15 patients had a migrated HD, including 7 patients with a low-grade down HD (sequestration), 7 patients with a high-grade down HD, and 1 patient with a low-grade up
Discussion
Endoscopic foraminoplasty was first introduced by Knight et al.7 Using a holmium-YAG side-firing laser, undercutting of the facet joint, discectomy, mobilization of the exiting and traversing nerve roots, and ablation of osteophytes could be performed. Foraminal widening techniques, called “foraminoplasty,” help surgeons access the epidural space, allowing visualization of hidden disc fragments and decompression of foraminal or lateral recess stenosis. Advances in endoscopic instruments, bone
Conclusions
Percutaneous endoscopic lumbar foraminoplasty may be effective for small DH, high-grade down migration, downward sequestration, recurrent HD, HD in L5-S1 with a high iliac crest, and central HD with a wide lamina angle.
Acknowledgments
The authors thank Hanna Lee, B.S., for support and assistance with this study.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.