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Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches

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Abstract

Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with “half-and-half” technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with “epiduroscopic” technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9–20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 ± 1.7 preoperatively to 2.6 ± 1.8 at the final follow-up (P < 0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations.

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Acknowledgments

The authors thank Dr. Ki-Bum Park, Hye-Ran Lee, Il Lee, and Ji-Hee Hwang for the help in preparing the manuscript and figures. This work was supported by a grant from the Wooridul Spine Foundation.

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Correspondence to Sang-Ho Lee.

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Lee, S., Kim, SK., Lee, SH. et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J 16, 431–437 (2007). https://doi.org/10.1007/s00586-006-0219-4

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  • DOI: https://doi.org/10.1007/s00586-006-0219-4

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