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Updated: Jul 2, 2025
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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
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Transforaminal Contrast Injection Before Computed Tomography-Guided Lateral Endoscopic Lumbar Diskectomy Improves
Adam Leibold1, Guilherme Porto1,2, Nikolaos Mouchtouris1
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia , Pennsylvania , USA.
Operative Neurosurgery (Hagerstown, Md.)
|February 22, 2024
Summary
A new technique combines computed tomography (CT) guidance with a neurogram for percutaneous endoscopic lumbar diskectomy (PELD). This approach enhances visualization of the exiting nerve root, improving safety and efficiency in minimally invasive spine surgery.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
- Radiological Guidance
Background:
- Percutaneous endoscopic lumbar diskectomy (PELD) offers effective, minimally invasive treatment for lateral lumbar disk herniations.
- Slower adoption of PELD in the US is linked to visualization challenges and longer operative times.
- Improved anatomical visualization is crucial for successful PELD procedures.
Purpose of the Study:
- To describe a novel technique for PELD using computed tomography (CT) guidance and a neurogram.
- To enhance visualization of critical anatomical structures during PELD.
- To detail the advantages of this combined guidance technique for surgeons.
Main Methods:
- A transforaminal injection of contrast under fluoroscopic guidance was performed.
- An intraoperative CT scan with a reference frame was acquired after sterile preparation.
- CT guidance was utilized to clearly outline the exiting nerve root during the procedure.
Main Results:
- The technique was successfully applied in a single revision PELD case.
- Enhanced visualization of the exiting nerve root was achieved.
- No intraoperative or postoperative complications were reported.
Conclusions:
- A novel technique integrating a neurogram with CT guidance facilitates PELD.
- This method aids in precise anatomical identification and nerve root decompression.
- The described technique offers a safe and effective adjunct for PELD procedures.
