J Korean Soc Spine Surg.  2007 Sep;14(3):212-219. 10.4184/jkss.2007.14.3.212.

Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation

• Chung JY
• Lee JJ

• KMID: 1941656
• DOI: http://doi.org/10.4184/jkss.2007.14.3.212

Abstract

Percutaneous endoscopic lumbar discectomy is a widely used procedure. In addition to the surgical techniques, the proper selection of the patients and appropriate approaching portal is important improving the clinical results. The choice of the approaching portal is related to the distance of migration and spinal canal encroachment in addition to the type of herniation type. In addition, it is essential to know the anatomic characteristics at each level of the lumbar spine in addition to the indications of the various approaching portals.

Keyword

Lumbar disc herniation; Percutaneous endoscopic discectomy

MeSH Terms

Diskectomy*
Humans
Spinal Canal
Spine

Figure

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  Fig. 1. Anatomical characteristics of lumbar spine (A) Relationships of the interpedicular distance, interlaminar space, and laminar overlap at each lumbar segment. (B) Schematic description of laminar overhanging

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  Fig. 2. Schematic diagram of the ‘Three-storied anatomical house concept’.

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  Fig. 3. Classification of the herniated disc related to the axial plane. A-intraspinal, B-foraminal, C-extraforaminal

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  Fig. 4. Considerations to select endoscopic approaching portals.

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  Fig. 5. Posterolateral approaching portal (A) uniportal method (B) biportal method

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  Fig. 6. Insertion angle of the transforaminal approaching portal not to injure the internal organ.

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  Fig. 7. Fluoroscopic image shows the obturator located just above superior wall of pedicle to avoid injury of the exit root.

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  Fig. 8. Sagittal (A) and coronal (B) reformatting images of the CT scan show the enough interlaminar space at L5-S1.

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  Fig. 9. Transiliac transforaminal approaching portal. (A) Axial T2-weighted MR image shows huge central disc herniaton related with bilateral symptoms. (B) Relationship between the iliac crest and neural foramen of L5-S1. (C, D) Intraoperative fluoroscopic images after insertion of cannula through the transiliac osseous tunnel. The dotted line represented an iliac crest.

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  Fig. 10. Diagram of the contralateral transforaminal approach. (A) Contralateral insertion of the obturator and cannula with the low angle than expected. (B) Advance of the cannula not to cross the midline with backward direction of the oblique surface to avoid compression of the central neural structure.

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  Fig. 11. Fluoroscopic images after insertion of the endoscope through the contralateral interlaminar space.

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  Fig. 12. Intertransverse approaching portal for extraforaminal disc hernation of L5-S1.

Reference

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