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Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients.
Minim Invasive Neurosurg. 2007 Apr; 50(2):91-7.MI

Abstract

BACKGROUND

Extraforaminal disc herniations represent up to 11% of all lumbar herniated discs. Numerous surgical approaches have been described. Percutaneous endoscopic discectomy (PED) is one of the minimally invasive techniques; after mastering this procedure it is a practical method that is used for treatment of foraminal or extraforaminal disc herniation. The outcome of PED for treatment of foraminal or extraforaminal disc herniation has been studied.

METHOD

A total of 66 patients with foraminal or extraforaminal lumbar disc herniation was treated by applying the PED technique between January 1998 and June 2005. The positions of the herniated disc levels were L2-3 (n=5, 8%), L3-4 (n=19, 28%) and L4-5 (n=42; 64%). The selected patients had no previous surgery, appropriate conservative therapies were done before the operations, and MRI was the main diagnostic method with the clinical findings. Evaluation of the patients with clinical examinations, visual analogue pain scale (VAS) and Oswestry scale was performed preoperatively, on postoperative day 7 and in the postoperative 6-12 months period.

RESULTS

In two patients (n=1, L4-5 and n=1, L3-4) disc material could not be removed with PED, so discectomy was performed with microscopic visualization during the same session. Three patients (n=3, L4-5) were reoperated on three to six months after primary surgery due to recurring disc problems with microscope visualization. In two patients (n=2, L4-5) root nerves were partially damaged, and in two patients (n=2, L4-5) root nerves were impinged by the working channel. These 4 patients had dysesthesias from just after surgery to a mean of 45 days after surgery. One of recurrent cases was among these patients. Neurological examinations showed minimal muscle weakness of the quadriceps femoris and diminished sensation of the L4 dermatomal area in patients with partial nerve root damage. This patient improved and the neurologic examination became normal with disappearance of the dysesthesia. There was no sign of reflex sympathetic dystrophy (RDS). With these two patients VAS and Oswestry scales scores decreased significantly early in the postoperative follow-up. The postoperative 6-month average scores are favourable in comparison with the average score at postoperative day 7. The postoperative 12-month scores showed no significant differences to those of postoperative month 1.

CONCLUSION

Percutaneous endoscopic discectomy is a minimally invasive method and offers many benefits to the patient, but extensive surgical practice is needed to become a capable surgeon. Consequently this technique can only be a treatment option on appropriate patients. This study reconfirmed that the removal of fragmented disc material is achieved and offers a pain-free status.

Authors+Show Affiliations

Sasani M
Neurosurgery Department, VKV American Hospital, Istanbul, Turkey. sasanim@gmail.com
Ozer AF
No affiliation info available
Oktenoglu T
No affiliation info available
Canbulat N
No affiliation info available
Sarioglu AC
No affiliation info available

MeSH

AdultAgedDiskectomy, PercutaneousEndoscopyFemaleHumansIntervertebral DiscIntervertebral Disc DisplacementLumbar VertebraeLumbosacral PlexusMagnetic Resonance ImagingMaleMiddle AgedMuscle WeaknessParesthesiaPostoperative ComplicationsProspective StudiesRisk AssessmentSpinal Nerve RootsTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17674295

Citation

Sasani, M, et al. "Percutaneous Endoscopic Discectomy for Far Lateral Lumbar Disc Herniations: Prospective Study and Outcome of 66 Patients." Minimally Invasive Neurosurgery : MIN, vol. 50, no. 2, 2007, pp. 91-7.
Sasani M, Ozer AF, Oktenoglu T, et al. Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg. 2007;50(2):91-7.
Sasani, M., Ozer, A. F., Oktenoglu, T., Canbulat, N., & Sarioglu, A. C. (2007). Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minimally Invasive Neurosurgery : MIN, 50(2), 91-7.
Sasani M, et al. Percutaneous Endoscopic Discectomy for Far Lateral Lumbar Disc Herniations: Prospective Study and Outcome of 66 Patients. Minim Invasive Neurosurg. 2007;50(2):91-7. PubMed PMID: 17674295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. AU - Sasani,M, AU - Ozer,A F, AU - Oktenoglu,T, AU - Canbulat,N, AU - Sarioglu,A C, PY - 2007/8/4/pubmed PY - 2007/10/18/medline PY - 2007/8/4/entrez SP - 91 EP - 7 JF - Minimally invasive neurosurgery : MIN JO - Minim Invasive Neurosurg VL - 50 IS - 2 N2 - BACKGROUND: Extraforaminal disc herniations represent up to 11% of all lumbar herniated discs. Numerous surgical approaches have been described. Percutaneous endoscopic discectomy (PED) is one of the minimally invasive techniques; after mastering this procedure it is a practical method that is used for treatment of foraminal or extraforaminal disc herniation. The outcome of PED for treatment of foraminal or extraforaminal disc herniation has been studied. METHOD: A total of 66 patients with foraminal or extraforaminal lumbar disc herniation was treated by applying the PED technique between January 1998 and June 2005. The positions of the herniated disc levels were L2-3 (n=5, 8%), L3-4 (n=19, 28%) and L4-5 (n=42; 64%). The selected patients had no previous surgery, appropriate conservative therapies were done before the operations, and MRI was the main diagnostic method with the clinical findings. Evaluation of the patients with clinical examinations, visual analogue pain scale (VAS) and Oswestry scale was performed preoperatively, on postoperative day 7 and in the postoperative 6-12 months period. RESULTS: In two patients (n=1, L4-5 and n=1, L3-4) disc material could not be removed with PED, so discectomy was performed with microscopic visualization during the same session. Three patients (n=3, L4-5) were reoperated on three to six months after primary surgery due to recurring disc problems with microscope visualization. In two patients (n=2, L4-5) root nerves were partially damaged, and in two patients (n=2, L4-5) root nerves were impinged by the working channel. These 4 patients had dysesthesias from just after surgery to a mean of 45 days after surgery. One of recurrent cases was among these patients. Neurological examinations showed minimal muscle weakness of the quadriceps femoris and diminished sensation of the L4 dermatomal area in patients with partial nerve root damage. This patient improved and the neurologic examination became normal with disappearance of the dysesthesia. There was no sign of reflex sympathetic dystrophy (RDS). With these two patients VAS and Oswestry scales scores decreased significantly early in the postoperative follow-up. The postoperative 6-month average scores are favourable in comparison with the average score at postoperative day 7. The postoperative 12-month scores showed no significant differences to those of postoperative month 1. CONCLUSION: Percutaneous endoscopic discectomy is a minimally invasive method and offers many benefits to the patient, but extensive surgical practice is needed to become a capable surgeon. Consequently this technique can only be a treatment option on appropriate patients. This study reconfirmed that the removal of fragmented disc material is achieved and offers a pain-free status. SN - 0946-7211 UR - https://www.unboundmedicine.com/medline/citation/17674295/Percutaneous_endoscopic_discectomy_for_far_lateral_lumbar_disc_herniations:_prospective_study_and_outcome_of_66_patients_ DB - PRIME DP - Unbound Medicine ER -