Qing-Feng Hu1, Hao Pan2, Yi-You Fang2, Gao-Yong Jia2. 1. Department of Orthopaedics, The Affiliated Guang-Xing Hospital of Zhejiang TCM University, Hangzhou, 310007, China. huqingfeng258@163.com. 2. Department of Orthopaedics, The Affiliated Guang-Xing Hospital of Zhejiang TCM University, Hangzhou, 310007, China.
Abstract
PURPOSE: The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach. METHODS: Three patients with high-grade down-migrated L3-4 and L4-5 disc herniation presented to our hospital. Each underwent PELD via a facet process and pedicle complex approach to remove the herniated fragment and achieve complete decompression of the nerve root. RESULTS: Patients' symptoms were relieved. Postoperative magnetic resonance imaging showed root decompression. Follow-up 12-month computed tomography revealed no pedicle or facet fracture and healing of the pedicle complex and facet process bone tunnel. CONCLUSION: PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.
PURPOSE: The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach. METHODS: Three patients with high-grade down-migrated L3-4 and L4-5 disc herniation presented to our hospital. Each underwent PELD via a facet process and pedicle complex approach to remove the herniated fragment and achieve complete decompression of the nerve root. RESULTS:Patients' symptoms were relieved. Postoperative magnetic resonance imaging showed root decompression. Follow-up 12-month computed tomography revealed no pedicle or facet fracture and healing of the pedicle complex and facet process bone tunnel. CONCLUSION: PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.
Authors: Alexander A Ivanov; Ahmad Faizan; Nabil A Ebraheim; Richard Yeasting; Vijay K Goel Journal: Spine (Phila Pa 1976) Date: 2007-10-15 Impact factor: 3.468