J Neurol Surg A Cent Eur Neurosurg 2020; 81(05): 472-474
DOI: 10.1055/s-0040-1701636
Surgical Technique

Epidural Catheter-Assisted Percutaneous Transforaminal Endoscopic Diskectomy: A Technical Note

Ki Joon Kim
1   Department of Neurosurgery, Nanoori Hospital Suwon, Suwon-si, Gyeonggi-do, Republic of Korea
,
JeeSoo Jang
1   Department of Neurosurgery, Nanoori Hospital Suwon, Suwon-si, Gyeonggi-do, Republic of Korea
,
Il-Tae Jang
2   Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, Republic of Korea
› Author Affiliations

Abstract

Background With advances in techniques and instruments, percutaneous endoscopic transforaminal lumbar diskectomy (PETLD) is now widely used for lumbar disk herniation. Although the indication for PETLD is expanding, the technique still has limitations. To overcome them, we performed the epidural catheter-assisted PETLD described here.

Methods A 49-year-old woman had severe radiating pain in a left L5 dermatomal distribution. Magnetic resonance imaging (MRI) revealed left paramedial disk herniation at L4–L5 and a small downward-migrated disk fragment. We performed epidural catheter-assisted PETLD. Mechanical outward pushing and normal saline injection through the epidural catheter were performed for removal of hidden disk remnants. In the second case, a 26-year-old man presented with severe radiating pain in the L5–S1 dermatoms on both sides. MRI revealed massive disk herniation at L4–L5. A unilateral approach was used, and the ruptured disk could be moved using an epidural catheter.

Results The patients' pain improved immediately after the procedures. With this method, neural decompression can be performed more easily and effectively.

Conclusions Epidural catheter-assisted PETLD has several advantages and can overcome the limitations of conventional PETLD.



Publication History

Received: 26 July 2019

Accepted: 22 October 2019

Article published online:
22 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Chen Z, Zhang L, Dong J. , et al. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine 2018; 28 (03) 300-310
  • 2 Choi KC, Kim JS, Park CK. Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation. Pain Physician 2016; 19 (02) E291-E300
  • 3 Kambin P, Zhou L. Arthroscopic discectomy of the lumbar spine. Clin Orthop Relat Res 1997; (337) 49-57
  • 4 Ahn Y, Jang IT, Kim WK. Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clin Neurol Neurosurg 2016; 147: 11-17
  • 5 Choi G, Lee SH, Lokhande P. , et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 2008; 33 (15) E508-E515
  • 6 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27 (07) 722-731
  • 7 Kambin P, O'Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 1998; (347) 150-167
  • 8 Pan L, Zhang P, Yin Q. Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy: a randomised controlled trial. Int J Surg 2014; 12 (05) 534-537
  • 9 Choi KC, Lee JH, Kim JS. , et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery 2015; 76 (04) 372-380 ; discussion 380–381; quiz 381
  • 10 Lee JH, Lee SH. Clinical effectiveness of percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation. Pain Physician 2012; 15 (03) 213-221
  • 11 Oh CH, Ji GY, Cho PG. , et al. The catheter tip position and effects of percutaneous epidural neuroplasty in patients with lumbar disc disease during 6-months of follow-up. Pain Physician 2014; 17 (05) E599-E608
  • 12 Pereira P, Severo M, Monteiro P. , et al. Results of lumbar endoscopic adhesiolysis using a radiofrequency catheter in patients with postoperative fibrosis and persistent or recurrent symptoms after discectomy. Pain Pract 2016; 16 (01) 67-79