One-Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double-Level Contiguous Adolescent Lumbar Disc Herniation

Abstract

Objective: To assess the clinical efficacy of one-stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double-level contiguous adolescent lumbar disc herniation (ALDH).

Methods: This retrospective study included 16 patients who presented with back and/or leg pain due to double-level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow-up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two-sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P < 0.05 were considered significantly different.

Results: There were 11 male and 5 female patients, with an average age of 19.3 years (range, 15-22 years). One case affected the L₂ - L₃ /L₃ -L₄ level, seven cases affected the L₃ - L₄ /L₄ - L₅ level, and eight cases affected the L₄ - L₅ /L₅ -S₁ level. The NRS scores decreased significantly in both early and late follow-up evaluations and these scores demonstrated significant improvement in late follow-up (P < 0.05). For the modified Macnab criteria, the final outcome results were excellent in 14 patients (87.5%), good in 1 patient (6.25%), fair in 1 patient (6.25%), and the overall success rate was 93.75%.

Conclusion: This study's data suggest that one-stage PELD is promising treatment strategy for selected symptomatic double-level contiguous adolescent lumbar disc herniation.

Keywords: Adolescent; Discectomy; Endoscopic; Herniation; Percutaneous.

Fig 1

A 17‐year‐old male was hospitalized for same‐side double‐level lumbar disc herniations causing unilateral radicular leg pain for 5 months undergoing one‐stage percutaneous endoscopic lumbar discectomy. (A) Preoperative sagittal MRI showing double‐lever lumbar disc herniation (L₄‐L₅, L₅‐S₁). (B) The single puncture point is determined by the intersection of two line. The point also depends on the location of the herniated disc, patient's body size. (C) The long 18‐gauge spinal needle was replaced with two guide wire. A 10‐mm skin incision was made close to the guide wire, and serial dilators are introduced. (D) After foraminoplasty, the working cannula was inserted into the foramen under fluoroscopic guidance. The surgeons usually operate the lower level at first. (E) Schematic diagram showing adjustment of spinal needle. (F) Schematic diagram showing adjustment of working cannula intraoperatively

Fig 2

A 21‐year‐old male was hospitalized for same‐side double‐level lumbar disc herniations causing unilateral radicular leg pain for 17 months undergoing one‐stage percutaneous endoscopic lumbar discectomy. (A) Preoperative sagittal MRI showing double‐level lumbar disc herniations causing unilateral radicular leg pain (L₃‐L₄,L₄‐L₅). (B) The long 18‐gauge spinal needle was replaced with two guide wire. (lateral). (C) The long 18‐gauge spinal needle was inserted into the foramen under fluoroscopic guidance (anterioposterior). (D) The trephine inserted over the guide wire into the L₃‐L₄ (anterioposterior). (E) Schematic diagram showing rod adjustment of working cannula intraoperatively. (F) The working cannula was inserted into the foramen under fluoroscopic guidance. The surgeons usually operate the upper level at first. (G) Intraoperative image showing exploration of the ipsilateral transversing nerve root after decompression

Fig 3

A 19‐year‐old female with bilateral symptomatic double‐lever lumbar disc herniation undergoing combined transforaminal and interlaminar PELD. (A) Preoperative sagittal MRI showing double‐lever lumbar disc herniation (L₄‐L₅,L₅‐S₁). (B) Preoperative axial MRI showing lumbar disc herniation (L₄–L₅,right). (C) Preoperative axial MRI showing lumbar disc herniation (L₅/S₁,left). (D) Schematic diagram showing spinal needle of combined transforaminal and interlaminar PELD intraoperatively. (E) Schematic diagram showing working cannula of combined transforaminal and interlaminar PELD intraoperatively

Fig 4

Clinical outcome using NRS scores.