Clin Orthop Surg.  2016 Sep;8(3):325-329. 10.4055/cios.2016.8.3.325.

Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

• Choi DJ
• Jung JT
• Lee SJ
• Kim YS
• Jang HJ
• Yoo B

• KMID: 2374280
• DOI: http://doi.org/10.4055/cios.2016.8.3.325

Abstract

The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH.

Keyword

Lumbosacral region; Intervertebral disc displacement; Minimally invasive surgical procedure; Endoscopic

MeSH Terms

Adult
Diskectomy/*methods
Endoscopy/*methods
Humans
Intervertebral Disc Displacement/*surgery
Lumbar Vertebrae/surgery
Lumbosacral Region/*surgery
Male
Minimally Invasive Surgical Procedures/*methods
Patient Positioning

Figure

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  Fig. 1 Preparation of the procedure. (A) The position of the patient with the back flat, the head down and the hip flexed. (B) The target point of spinal needle insertion for dyeing of the disc. (C) Biportal inlets were located over the margin of the interlaminar space rather than the level of disc space.

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  Fig. 2 Revision biportal endoscopic spine surgery. (A) With the bony margin of the facet exposed, adhesiolysis of scar tissue was safely performed from the bony tissue of the lamina under excellent magnification and bright illumination with curetting to differentiate it from soft tissue scar. (B) Decompression somewhat wider with a Kerrison punch to make a room for inspecting the disc space. (C) Probing and searching the disc space along the bony margin of the pedicle to the base. (D) Stained basal area indicated the ruptured disc level. (E) The ruptured disc fragment stained by indigo carmine was exposed at the ruptured site. (F) The ruptured fragment was removed by a hook.

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  Fig. 3 A 43-year-old male patient with recurring lumbar disc herniation (LDH) at L5–S1. (A) Magnetic resonance imaging (MRI) scans of the ruptured disc in the first event. (B) Postoperative axial MRI scans after open microdiscectomy. (C) Axial and sagittal views of the recurring LDH at 7 months after the first operation. (D) Postoperative MRI scans after the revision surgery: biportal endoscopic spine surgery with decompression of the affected disc and preservation of the facet.

Reference

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