Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L4-L5 disc through an L5-S1 interlaminar...

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery

Background:

• L4-L5 disc herniations are common and can be treated with percutaneous endoscopic lumbar discectomy (PELD).
• Inadequate decompression is a significant cause of PELD failure, particularly in high-grade migrations.
• The transforaminal posterolateral approach may have limitations in achieving adequate decompression for certain herniations.

Purpose of the Study:

• To introduce and evaluate a novel L5-S1 interlaminar endoscopic approach for PELD.
• To address the challenge of treating high-grade, down-migrated L4-L5 disc herniations.
• To present a technique that potentially overcomes decompression limitations of other PELD approaches.

Main Methods:

• A technical report detailing the PELD procedure using an L5-S1 interlaminar approach.
• Four consecutive patients with high-grade, down-migrated L4-L5 disc herniations were treated.
• Procedures were performed under local anesthesia with conscious sedation.
• Clinical outcomes were assessed using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).
• Radiological evaluation included postoperative MR imaging.

Main Results:

• All four patients showed immediate postoperative improvement in symptoms.
• Mean VAS scores for back pain decreased from 3.75 to 1.75.
• Mean VAS scores for leg pain decreased significantly from 8.5 to 0.75.
• Mean ODI scores improved from 65% to 3%.
• Postoperative MR imaging confirmed successful L5 root decompression.
• No intraoperative or postoperative complications were reported.

Conclusions:

• The L5-S1 interlaminar endoscopic approach is a viable new technique for PELD.
• This method effectively treats high-grade, down-migrated L4-L5 disc herniations.
• The technique offers a safe and effective alternative for challenging lumbar disc herniations.