The Internet Journal of Minimally Invasive Spinal Technology 2009 : Supplement II - to IJMIST Vol III No 4

Percutaneous Endoscopic Discectomy In Lumbar Disc Herniation Combined With Spinal Stenosis Having Severe Unilateral Radiculopathic Leg Pain Caused By Dominant Root Compression: Transforaminal Suprapedicular Approach

Chang Il Ju MD
Department Of Neurosurgery
Chosun University

Hyeun Sung Kim M.D.
Department Of Neurosurgery
Chosun University

Seok Won Kim M.D.
Department Of Neurosurgery
Chosun University

Seung Myung Lee M.D.
Department Of Neurosurgery
Chosun University

Ho Shin M.D.
Department Of Neurosurgery
Chosun University

Citation: C. Il Ju, H. Kim, S. Kim, S. Lee & H. Shin : Percutaneous Endoscopic Discectomy In Lumbar Disc Herniation Combined With Spinal Stenosis Having Severe Unilateral Radiculopathic Leg Pain Caused By Dominant Root Compression: Transforaminal Suprapedicular Approach. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4


Abstract

Objective: Endoscopic discectomy for lumbar disc herniation combined spinal stenosis have been considered as contraindication. But, we could have obtained satisfactory results from the cases of lumbar disc herniation combined with spinal stenosis that have symptoms of severe radiculopathic leg pain with or without back pain caused by compression traversing nerve root in lateral recess by applying percutaneous endoscopic discectomy. Hence, the outcome is reported here. Materials and Methods: At our hospital, from October 2006 to December 2007. The subjects were 26 patients with lumbar disc herniation combined with spinal stenosis. All patients had severe unilateral leg radiating pain and/or back pain symptoms caused by dominantly herniated disc compressing the nerve root. Preoperative MR T2 weighted axial images show spinal stenotic findings that more than 4mm thickened ligament flavum and evident protruded disc to compress the traversing nerve root. We had performed percutaneous transforaminal decompressive discectomy and then decompressed traversing root by suprapedicular approach with semi-rigid flexible curved probe. Results: There were 26 patients, 7 male and 19 female patients. One patient was in her 20's, one patient in their 30's, four patients in their 40's, seven patients were in their 50's and eight patients were in their 60's, five patients were in their 70's. Mean follow-up was 6.37 month. The mean visual analogue scale (VAS) of the patients prior to surgery was 8.08, and the mean postoperative VAS was 2.08. According to Macnab's criteria, patients who showed excellent result were 6 cases and good result were 17 cases, fair results were 2 cases, poor result was 1 case and thus satisfactory results were obtained in 88.46 % cases. Conclusion: Generally, the lumbar disc herniation combined with spinal stenosis is known as contraindication of endoscopic discectomy. But, If main symptoms was caused by herniated disc compression traversing nerve root in the lateral recess, percutaneous lumbar discectomy could effective methods to decompress the traversing root by transforaminal suprapedicular approach.

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