Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram
Journal of Korean Neurosurgical Society 2009³â 46±Ç 4È£ p.312 ~ p.316
ä±âȯ(Chae Ki-Hwan) - Á¶¼±´ëÇб³ ÀÇ°ú´ëÇÐ ½Å°æ¿Ü°úÇб³½Ç
ÁÖâÀÏ(Ju Chang-Il) - Á¶¼±´ëÇб³ ÀÇ°ú´ëÇÐ ½Å°æ¿Ü°úÇб³½Ç
À̼º¸í(Lee Seung-Myung) - Á¶¼±´ëÇб³ ÀÇ°ú´ëÇÐ ½Å°æ¿Ü°úÇб³½Ç
±èº´¿í(Kim Byoung-Wook) - Á¶¼±´ëÇб³ ÀÇ°ú´ëÇÐ ½Å°æ¿Ü°úÇб³½Ç
(Kim Saeng-Youp) - Á¶¼±´ëÇб³ ÀÇ°ú´ëÇÐ ½Å°æ¿Ü°úÇб³½Ç
±èÇö¼º(Kim Hyeun-Sung) - Ç㸮»ç¶ûº´¿ø ½Å°æ¿Ü°ú
Abstract
Objective: The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations.
Methods: The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach.
Results: The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab¡¯s criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases.
Conclusion: In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.
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Intervertebral disc herniation, Percutaneous discectomy, Posterolateal approach
KMID :
1001920090460040312
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À¯È¿¼º°á°ú(Recomendation)
Patients who had high grade, non-contained-type disc herniation were treated with PELD and non-contained-type disc herniation was removed by endoscopic approach.