Korean J Pain.  2016 Jan;29(1):57-61. 10.3344/kjp.2016.29.1.57.

A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop

• Chun EH
• Park HS

• KMID: 2151662
• DOI: http://doi.org/10.3344/kjp.2016.29.1.57

Abstract

Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy.

Keyword

Drop foot; Endoscopy; Herniated disc; Local anesthesia; Low back pain; Percutaneous discectomy

MeSH Terms

Anesthesia, Local
Diskectomy*
Diskectomy, Percutaneous
Endoscopes
Endoscopy
Epidural Space
Foot*
Humans
Intervertebral Disc Displacement
Laminectomy
Low Back Pain

Figure

• 

  Fig. 1 Preoperative magnetic resonance imaging showed disc extrusion to the left extraforaminal zone with superior foraminal migration below the L5 pedicle with a left L5 nerve compression. (A) Sagittal view, (B) axial view.

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  Fig. 2 The needle trajectory and skin entry point was decided using preoperative MRI. The skin entry point was closer (9 cm) and the angle of needle insertion was steeper (42 degree) than those of transforaminal approach (10−13 cm, 25−30 degree) [1112].

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  Fig. 3 Intraoperative fluoroscopic images showing the working cannula in the epidural space.

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  Fig. 4 Postoperative magnetic resonance imaging obtained 1 day after the procedure showing improvement of left L5 nerve compression and the resolution of the disc fragment in the left extraforaminal zone. (A) Sagittal view, (B) axial view.

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