Technical Note 147 Choi G et al. Percutaneous Endoscopic Lumbar Herniectomy for High-Grade Down-Migrated … Minim Invas Neurosurg 2010; 53: 147–152 Bibliography DOI http://dx.doi.org/ 10.1055/s-0030-1254145 Minim Invas Neurosurg 2010; 53: 147–152 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0946-7211 Correspondence Dr. H. N. Modi Department of Orthopedic Surgery Wooridul Spine Hospital 47-4 Chungdam-dong Gangnam-gu Seoul 135-100 Korea Tel.: + 82/2/513 8151 Fax: + 82/2/513 8146 modispine@yahoo.co.in Key words ● ▶ percutaneous endoscopic lumbar discectomy ● ▶ high-grade down-migrated L4–L5 disc ● ▶ L5-S1 interlaminar approach ● ▶ minimally invasive spine surgery Percutaneous Endoscopic Lumbar Herniectomy for High-Grade Down-Migrated L4–L5 Disc through an L5- S1 Interlaminar Approach: A Technical Note herniations [1–4]. Originally, it was devised to treat only contained lumbar disc herniations (LDH). With growing experiences and advances in technology, the spectrum of PELD is gradually expanding day by day with some of the contrain- dications of the past now becoming the indica- tions of the present [2, 5–14]. Modern endoscopic surgeons are able to deal with a non-contained extruded disc, a migrated disc, or even a seques- trated disc through a transforaminal posterola- teral endoscopic approach, as described by Kambin et al. [2], using local anesthesia. Patients with extraforaminal LDH, LDH with foraminal narrowing, a difficult L5-S1 level, or a high iliac crest can now be treated with PELD [8, 14–16]. Recently, Choi et al. [15] reported successful results after treating patients with a difficult L5- S1 level (due to a high iliac crest and narrow transforaminal area) and intracanalicular disc herniations with L5-S1 interlaminar PELD, using a rigid working channel endoscope. At our insti- Abbreviations ▼ LDH lumbar disc herniation PELD percutaneous endoscopic lumbar discectomy PELH percutaneous endoscopic lumbar herniectomy Introduction ▼ Minimally invasive spine surgery (MISS), with a focus on preserving normal spinal anatomy, is gradually replacing the traditional open lumbar discectomy that requires laminectomy or lami- notomy. Percutaneous endoscopic lumbar dis- cectomy (PELD), a minimally invasive spine surgical procedure developed and popularized by pioneers such as Hijikata, Kambin, Yeung and others, has become a versatile minimally invasive spine surgical procedure for treating lumbar disc Authors G. Choi 1 , N. Prada 2 , H. N. Modi 2 , N. B. Vasavada 2 , J.-S. Kim 1 , S.-H. Lee 1 Affiliations 1 Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea 2 Department of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, South Korea Abstract ▼ Background: L4–L5 disc herniations can be treated with percutaneous endoscopic lumbar discectomy (PELD) using a transforaminal pos- terolateral approach. Although PELD has some distinct advantages over conventional open dis- cectomy, inadequate decompression is a major cause of failure of the procedure, especially with high-grade migrations. The objective of this tech- nical note is to present a new surgical approach for treating high-grade, down-migrated, L4–L5 disc herniations through an L5-S1 interlaminar endoscopic approach. Method: This technical report presents 4 consecutive patients with high-grade, down- migrated, L4–L5 disc herniations, who were treated with PELD through an L5-S1 interlaminar approach under local anesthesia and conscious sedation. All patients were evaluated clinically using both the visual analogue scale (VAS) for back and leg pain and the Oswestry disability index (ODI) and radiologically using MR imaging postoperatively. Results: All 4 patients experienced improve- ment in their preoperative symptoms and signs immediately postoperatively. The mean VAS scores for back and leg pain improved from 3.75 to 1.75 and from 8.5 to 0.75, respectively. The mean ODI score improved from 65 % to 3 %. Postoperative MR imaging also depicted L5 root decompression. There were no complications during the procedure. Conclusion: This technical note presents a new technique for treating high-grade, down- migrated, L4–L5 disc herniations with PELD using an L5-S1 interlaminar approach. Downloaded by: Medical school of Inje University. Copyrighted material.