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. 2016:2016:6250247.
doi: 10.1155/2016/6250247. Epub 2016 Oct 10.

Structural Preservation Percutaneous Endoscopic Lumbar Interlaminar Discectomy for L5-S1 Herniated Nucleus Pulposus

Jung-Sup Lee  1 , Hyeun-Sung Kim  1 , Jee-Soo Jang  1 , Il-Tae Jang  2
Affiliations

Structural Preservation Percutaneous Endoscopic Lumbar Interlaminar Discectomy for L5-S1 Herniated Nucleus Pulposus

Jung-Sup Lee et al. Biomed Res Int. 2016.

Abstract

Objective. Structures such as ligamentum flavum, annulus, and lamina play an important role in the segmental function. We proposed the surgical technique for achieving the sufficient preservation of segmental structures, in spite of sufficient removal of pathologic disc in the L5-S1 using the ligamentum flavum splitting and sealing technique. Methods. We retrospectively analyzed 80 cases that underwent percutaneous endoscopic lumbar discectomy for L5-S1 herniated nucleus pulposus, using the ligamentum flavum splitting and sealing technique between January 2011 and June 2013. Outcomes were assessed using VAS (leg, back), MacNab's criteria, and the immediate postoperative MRI for all patients. Structural preservation was classified as complete, sufficient, and incomplete. Results. The surgical results are as follows: 65 cases were complete, 15 cases were sufficient, and 0 cases were incomplete. The VAS was decreased at the last follow-up (leg: from 7.91 ± 0.73 to 1.15 ± 0.62; back: from 5.15 ± 0.71 to 1.19 ± 0.75). A favorable outcome (excellent or good outcome by MacNab's criteria) was achieved in 77 patients (96.25%). During the follow-up period, 2 cases (2.5%) of recurrence have occurred. Conclusion. According to the result, we could obtain the favorable clinical and radiological outcomes while simultaneously removing pathologic discs using the ligamentum flavum splitting and annular fissure sealing technique.

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Figures

Figure 1
Figure 1
Surgical procedures. (a) Preoperative T2-weighted magnetic resonance image (MRI) shows the shoulder type disc herniation. (b) Preoperative T2-weighted MRI shows the axillar type disc herniation. (c) Ligamentum flavum vertical splitting performed using a dissector more laterally in shoulder type (A) and more caudally in axillar type (B). (d) and (e) Introduced the working channel bevel into the splitting area and rotated to widen the opening. And then we retract the thecal sac or root using working channel bevel in shoulder type (d) and axillar type (e).
Figure 2
Figure 2
Intraoperative endoscopic view showing the ligamentum flavum. (a) Ligamentum flavum splitting using dissector in vertical direction. (b) Rotating and introducing the working channel bevel into the epidural space. (c) After the operation, closed ligamentum flavum splitting line was seen when the working channel was removed.
Figure 3
Figure 3
Images during the endoscopic discectomy with annular sealing. (a) Before annular sealing, annular defect was seen (black arrow). (b) Annular sealing using bipolar coagulation. (c) After annular sealing, the annular defect became smaller (black arrow).
Figure 4
Figure 4
Radiological results using MRI. (a) and (b) Categorized as complete. Pre- and postoperative MRI showing the preserved ligamentum flavum, complete pathologic disc removal, and complete annulus restoration. (c) and (d) Categorized as sufficient. Pre- and postoperative MRI showing the preserved ligamentum flavum, complete pathologic disc removal, and incomplete annulus restoration.
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