Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Spine Surgery

Background:

• High-grade down-migrated lumbar disc herniations medial to the pedicle traditionally require extensive laminectomy and facetectomy.
• These extensive procedures carry risks of iatrogenic spinal instability.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of a direct percutaneous endoscopic transpedicular approach for treating down-migrated lumbar disc herniations.
• To offer an alternative surgical technique that minimizes spinal instability.

Main Methods:

• A transpedicular approach was utilized, involving the creation of a tunnel through the pedicle.
• Access to the parapedicular epidural space was achieved through this tunnel.
• Herniated disc material was removed via endoscopic visualization.

Main Results:

• The transpedicular endoscopic technique successfully accessed herniated discs located medially to the pedicle.
• The procedure allowed for safe and effective removal of the migrated disc fragments.
• This approach avoids the need for extensive bone resection, mitigating risks of instability.

Conclusions:

• The percutaneous endoscopic transpedicular approach is a feasible and effective surgical option for down-migrated lumbar disc herniations.
• This technique provides a safe alternative to traditional open surgeries, preserving spinal stability.