A Modified Percutaneous Endoscopic Technique to Remove Extraforaminal Disk Herniation at the L5-S1 Segment

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery

Background:

• Extraforaminal disk herniation at the L5-S1 segment presents unique surgical challenges.
• Percutaneous endoscopic lumbar diskectomy (PELD) is an established technique, but modifications may improve outcomes for specific herniation types.

Purpose of the Study:

• To introduce a modified PELD technique for treating extraforaminal disk herniation at the L5-S1 level.
• To detail the technical aspects and report preliminary outcomes of this modified approach.

Main Methods:

• Geometric parameters of the transverse process, facet joint, and sacrum (TFS) space were measured in 100 patients.
• A modified PELD technique was developed, focusing on working cannula placement and disk removal through the TFS space.
• Ten patients with L5-S1 extraforaminal disk herniation underwent the modified PELD procedure.

Main Results:

• The TFS space dimensions were quantified, providing anatomical guidance for the procedure.
• All 10 patients returned to their previous activities within one month post-surgery.
• Significant reductions in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were observed post-operation, with sustained improvement at 30 days.
• No neurological deficits or surgical site infections were reported.

Conclusions:

• The modified PELD technique is a safe and effective minimally invasive option for extraforaminal disk herniation at L5-S1.
• The study outlines a detailed protocol for nerve protection during herniated disk removal.
• This technique offers a less invasive alternative with positive preliminary results.