J Minim Invasive Spine Surg Tech.  2024 Jul;9(Suppl 2):S95-S101. 10.21182/jmisst.2024.01298.

Transpedicular Percutaneous Discectomy for High-Grade Down-Migrated Lumbar Disc Herniation

• González-Murillo M
• Campos AR
• Oliveira ES
• Silva M
• Toral JC
• de Mon-Montoliú J
• Benítez FJS
• Casal Grau R

• KMID: 2562254
• DOI: http://doi.org/10.21182/jmisst.2024.01298

Abstract

Objective
The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration.
Methods
The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis.
Results
The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p<0.05).
Conclusion
At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.

Keyword

Transpedicular approach; Discectomy; Endoscopic discectomy; High-grade down-migrated; Lumbar disc herniation