Research ArticleArticles

Percutaneous Transpedicular Lumbar Endoscopy: A Case Report

Priyank Uniyal, Gun Choi and Bhushan Khedkkar
International Journal of Spine Surgery January 2016, 10 31; DOI: https://doi.org/10.14444/3031

Article Figures & Data

Figures

  • Fig. 1
    Fig. 1

    Preoperative MRI. 1a: saggital T2W down migrated disc, 1b: axial T2W with down migrated disc herniation upto the inferior pedicle level.

  • Fig. 2
    Fig. 2

    Postoperative MRI and CT. 2a: saggital T2W removal of herniated disc. 2b: axial T2W showing complete decompression upto the inferior level of the pedicle. 2c &2d: saggital and axial CT shows the entry of transpedicular approach through the pedicle (yellow circle).

  • Fig. 3
    Fig. 3

    Endoscopic view. 3a: drilling of medial pedicular wall 3b: tail of sequestered disc (SD); dotted line demarcates the medial pedicle wall. 3c: removal of herniated fragment with an endoscopic forceps.

  • Fig. 4
    Fig. 4

    Preoperative MRI. 4a: saggital T2W discal cyst, 4b: T2W axial showing discal cyst at the medial aspect of L4 left pedicle.

  • Fig. 5
    Fig. 5

    Postoperative MRI & CT. 5a: Complete removal of discal cyst on sagg T2W; 5b: T2W axial complete decompression and drain placed in situ; 5c & 5d: saggital and axial CT shows the transpedicular entry point and trajectory through the pedicle (yellow circle).

  • Fig. 6
    Fig. 6

    Endoscopic view. 6a: the black dotted line shows the ruptured and collapsed discal cyst wall, the blue dotted line demarcates dura. 6b: tail of herniated disc fragment being grabbed by an endoscopic forceps. 6c: canal space after removal of discal cyst (NR – nerve root).

  • Fig. 7
    Fig. 7

    1) Local anesthetic 2) Dye for discography 3) 23 G discography needle 4) 18 G endoscopy needle 5) guide wire, 6 ) & 8) Triphines, 7) & 10) cannula 9) obturator 11) Endoscopic Drill 12) Endoscope.

  • Fig. 8
    Fig. 8

    Intraoperative fluoroscopy. 8a: discography with extravasation of the dye; 8b: needle placement transpedicularly; 8c: reaming by triphine; 8d: final cannula placement; 8e: endoscopic drilling of medial pedicle wall, 8f & 8g: endoscopic forceps placement during removal of herniated disc fragment.

  • Fig. 9
    Fig. 9

    The blue line indicates the trajectory of transpedicular endoscopy and yellow circle denotes the target point which has to be drilled endoscopically.

Tables

  • Table 1

    Anatomic characteristics of lumbar pedicle.

    LevelMean transverse diameter (millimetres)Mean medial an-gulation (degrees)Mean sagittal (caudal) angulation (degrees)
    L1814.52.6
    L27.814.22.7
    L310.218.52.7
    L413.416.63.9
    L518.024.65.5
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Percutaneous Transpedicular Lumbar Endoscopy: A Case Report
Priyank Uniyal, Gun Choi, Bhushan Khedkkar
International Journal of Spine Surgery Jan 2016, 10 31; DOI: 10.14444/3031
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