Percutaneous Endoscopic Lumbar Herniectomy for High-Grade Down-Migrated L4-L5 Disc through an L5-S1 Interlaminar Approach: A Technical Note.

Minim Invasive Neurosurg. 2010 Jun;53(3):147-152

Authors: Choi G, Prada N, Modi HN, Vasavada NB, Kim JS, Lee SH

BACKGROUND: L4-L5 disc herniations can be treated with percutaneous endoscopic lumbar discectomy (PELD) using a transforaminal posterolateral approach. Although PELD has some distinct advantages over conventional open discectomy, inadequate decompression is a major cause of failure of the procedure, especially with high-grade migrations. The objective of this technical 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 improvement 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.

PMID: 20809458 [PubMed - as supplied by publisher]

High-Definition Imaging in Spinal Neuroendoscopy.

Minim Invasive Neurosurg. 2010 Jun;53(3):142-146

Authors: Philipps M, Oertel J

BACKGROUND: Spinal endoscopy is still under controversial discussion. An often acclaimed critic is the poor endoscopic image quality in comparison with the microscope. Since high-definition digital cameras have recently been introduced into spinal neuroendoscopy, the aim of the current study is to examine whether superior image quality has a relevant impact on intraoperativen orientation. MATERIAL AND METHODS: A lumbar endoscopic discectomy was recorded simultaneously in High-Definition resolution (HD) and Standard-Definition resolution (SD). 10 experienced spinal surgeons were asked to identify predefined as well as not predefined anatomic structures in HD and SD resolution. Additionally, the video quality was rated with grades from 1 ("very good") to 6 ("poor"). RESULTS: Out of 14 predefined structures an average of 7.8+/-3.3 structures (55.71%) were identified in HD, 4.4+/-3.2 structures (31.43%) in SD (p=0.03). Out of 14 not predefined anatomical structures, 5.9+/-3.6 were correctly identified in HD, 2.6+/-2.5 in SD (p=0.05). Misinterpretation of structures occurred in 1.4+/-1 cases in HD, compared to 3+/-2.2 in SD (p=0.05). Subjective impression of video quality was rated 2.2 ("good") for HD, 3.0 ("satisfactory") for SD (p=0.03). CONCLUSION: HD in endoscopic discectomy accounts for a significantly more reliable identification of anatomic structures in freeze-images in comparison with standard definition images. Additionally, the subjective impression of video quality is significantly better in HD. This superior identification of structures might contribute to improve intraoperative orientation in endoscopic neurosurgery using high definition quality technology.

PMID: 20809457 [PubMed - as supplied by publisher]