Unilateral BIPORTAL endoscopic translaminar approach to treat up-migrated lumbar disc herniation: 12 cases report

There are difficulties on removing migrated disc herniation (MDH) using a microscope. The purpose of this study was to introduce a unilateral biportal endoscopic (UBE) translaminar approach to treat up-migrated lumbar disc herniation (LDH).

A total of 12 patients from March 2021 to February 2022 with up-migrated LDH were treated with a UBE translaminar approach. Clinical outcomes such as a visual analog scale (VAS) (back and leg pain) and MacNab criteria were assessed preoperative, postoperative, and 1 month after surgery.

Seven patients were diagnosed with high-grade up-migrated LDH, while five patients presented very-high grade up-migrated LDH. In all cases, the migrated LDH were removed completely and were confirmed by postoperative magnetic resonance imaging. The VAS for back pain were improved from 4.5 (SD = 3.1) to 2.0 (SD = 1.0) and 1.0 (SD = 1.0) for immediately postoperative and in 1-month follow-up, respectively, showing a statistically significant difference (p < 0.001). VAS for leg pain was 6.5 (SD = 2.5) preoperatively to 2.3 (SD = 1.1) and 0.8 (SD = 0.4) immediately postoperative and 1-month follow-up, respectively, also showing a significant difference (p < 0.001). According to the MacNab criteria, we observed excellent outcomes in 66.6% and good outcomes in 33.3%.

The UBE translaminar approach showed a high success rate with high patient satisfaction for the management of up-migrated LDH. It could be considered a feasible alternative surgical option to treat up-migrated LDH.