Document Detail

Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches.
MedLine Citation:
PMID:  16972067     Owner:  NLM     Status:  MEDLINE    
Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with "half-and-half" technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with "epiduroscopic" technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9-20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 +/- 1.7 preoperatively to 2.6 +/- 1.8 at the final follow-up (P < 0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations.
Seungcheol Lee; Seok-Kang Kim; Sang-Ho Lee; Won Joong Kim; Won-Chul Choi; Gun Choi; Song-Woo Shin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-09-14
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  16     ISSN:  0940-6719     ISO Abbreviation:  Eur Spine J     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-19     Completed Date:  2007-06-05     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  431-7     Citation Subset:  IM    
Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong Kangnam-gu, Seoul 135-100, South Korea.
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MeSH Terms
Diskectomy, Percutaneous / methods*
Endoscopy / methods*
Intervertebral Disc Displacement / classification*,  pathology,  surgery*
Lumbar Vertebrae / pathology,  surgery*
Magnetic Resonance Imaging
Middle Aged
Treatment Outcome

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