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Clinical Results of Percutaneous Rigid Endoscopic Lumbar Discectomy for Various Types of the Lumbar Disc Herniations

Hyeun Sung Kim(neuros@dreamwiz.com)1 Chang Il Ju2, Seok Won Kim2, Seung Myung Lee2, Ho Shin2. Clinical Results of Percutaneous Rigid Endoscopic Lumbar Discectomy for Various Types of the Lumbar Disc Herniations.

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Clinical Results of Percutaneous Rigid Endoscopic Lumbar Discectomy for Various Types of the Lumbar Disc Herniations

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  1. Hyeun Sung Kim(neuros@dreamwiz.com)1 Chang Il Ju2, Seok Won Kim2, Seung Myung Lee2, Ho Shin2 Clinical Results of Percutaneous Rigid Endoscopic Lumbar Discectomy for Various Types of the Lumbar Disc Herniations 1Hurisarang Hospital, Department of Neurosurgery, Daejeon, Republic of Korea2College of Medicine, Chosun University, Department of Neurosurgery, Kwangju, Republic of Korea

  2. Historical Review • Primary Intradiscal Aproach • 1977 - Hijikata : Percutaneous manual discecotmy (non-selective, not concurrent with surgical identification) • 1983 - Kambin & Gellman : Non-visualized posterolateral percutaneous nucleotomy • . 1984 - Ascher : Percutaneous laser discectomy(nonspecific depressurization) • Modification of intradiscal approach : Visualized • 1987 - Schreiber : transdiscoscopic percutaneous nucleotomy • 1988 - Kambin : arthroscopic microdiscectomy: Published the first intraoperative discoscopic view of a HNP. • 1989 - Mayer : percutaneous endoscopic lumbar discectomy • 1991 - Davis : percutaneous endoscopic laser disc decompression • 1991 - Kambin : Described & illustrated the triangular working zone & the midpedicle line • Transforaminal approach • 1996 - Kambin : Foraminal arthroscopic decompression of lateral recess stenosis : annulectomy & osteophtectomy • 1996 - Mathews : transforaminal endoscopic microdiscectomy • 1996 - Siebert : endoscopic laser disc surgery : the foraminal app. • 1996 - Lew : percutaneous foraminoscopy • 1996 - Casper : foraminal laser endoscopic disc ablation • Foraminoplasty approach • 1996 - Knigh : endoscopic laser foraminoplasty • 1997 - Yeung : YESS : Introduced a rigid rod-lens, integrated, multichannel, wide-angle operating spinal endoscope. • 1997 - Hoogland : percutaneous endoscopic discectomy • 1998 - Yeung : selective endoscopic discectomy • 1999 - chiu : microdecompressive percutaneous discectomy with laser thermodiskoplasty • Further advance approach • 2002 : Yeung : Transforaminal endoscopic decompression : intracanal noncontained lumbar disc • 2004 : Ahn : Percutaneous Endoscopic Lumbar Discectomy for Recurrent Disc Herniation • 2005 : Ruetten : Extreme lateral access : full-endoscopic uniportal transforaminal approach • 2006 : Lee : Percutaneous endoscopic lumbar discectomy for migrated disc herniation • 2006 : Lee : Operative Failure of Percutaneous Endoscopic Lumbar Discectomy Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  3. Introduction Various types of lumbar disc herniation Difficulties of percutaneous rigid endoscopic lumbar discectomy • Anatomical limitation • Excessive foraminal migration • A centrally located large calcified disc • Presence of bony osteophytes • Presence of residual epidural scarring • Limitation of operative view Far lateral type Foraminal type Central type Paracentral type • High grade migrated type disc • High canal compromised type disc • Stenosis combined type disc • Far lateral and Foraminal type disc Migration type Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  4. Material and Methods Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  5. Methods : Endoscopic Approach Preoperative 3D image and targeting Semi-rigid flexible Curved Probe Suprapedicular Approach Decompression for Spinal Stenosis Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  6. Methods : Endoscopic Approach Preoperative 3D imaging and targeting • Indication • Superior or inferior migrated disc • Foraminal disc • Far lateral disc • Ruptured disc Semi-rigid flexible Curved Probe Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  7. Methods : Endoscopic Approach Suprapedicular Approach • Indication • Far down inferior migration type • High canal compromised type • Stenosis combined type Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  8. Results Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  9. Results Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  10. Results Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  11. Cases Inferior Migration Type Preoperative Preoperative Postoperative Postoperative Preoperative Postoperative Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  12. Cases Far Lateral Type Central Protrusion Type Preoperative Preoperative Preoperative Postoperative Postoperative Postoperative Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  13. Cases Superior Migration Type Preoperative Postoperative Preoperative Postoperative Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  14. Cases Foraminal Type Preoperative Postoperative Preoperative Postoperative Postoperative Preoperative Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  15. Cases HNP L5-S1 : Interlaminar Approach Preoperative Postoperative Preoperative Postoperative Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  16. Cases Stenosis Combined Type Preoperative Postoperative Preoperative Preoperative Postoperative Postoperative Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  17. Discusssion Outcome of lumbar discectomy Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  18. Discusssion • Eliminating the possibility of resection of bone and ligament • Performing selective evacuation of the intervertebral space • Preventing surgery-induced instabilities • Avoidance of Scarring • Conservation of intact intra-epidural lubricant structures • No need for general anesthesia • Less complications and morbidity in the elderly • Shorter hospital stays • Faster rehabilitation • Earlier return to work or sports • Higher patient satisfaction Advantages of Percutaneous endoscopic lumbar discectomy Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  19. Discusssion Difficulties in percutaneous rigid endoscopic lumbar discectomy Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  20. Discusssion New techniquies for percutaneous rigid endoscopic lumbar discectomy • Choi G, Lee SH, Raiturker PP, Lee S, Chae YS. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery. 2006 Feb;58(1 Suppl):ONS59-68 • Kim MJ, Lee SH, Jung ES, Son BG, Choi ES, Shin JH, Sung JK, Chi YC. Targeted percutaneous transforaminal endoscopic disckectomy in 295 patients: comparison with results of microscopic diskectomy. Surg Neurol. 2007 Dec;68(6):623-31. • Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS. Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine. 2007 Jan 15;32(2):E93-9. • Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine. 2008 Jul 1;33(15):E508-15. • Kim HS, Ju CI, Kim SW, Kim JG. Endoscopic transforaminal suprapedicular approach in high grade inferior migrated lumbar disc herniation. J Korean Neurosurg Soc. 2009 Feb;45(2):67-73. • Ahn Y, Lee SH, Lee JH, Kim JU, Liu WC. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien). 2009 Mar;151(3):199-206. Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

  21. Conclusion Compared to traditional microdiscectomy, percutaneous endoscopic lumbar discectomy is regarded as difficult, with a poor outcome, and a high recurrence rate. In our hands, however, the results of percutaneous endoscopic lumbar discectomy for all patients with discogenic radiculopathy were satisfactory and the recurrence rate was not high. Hyeun Sung Kim (neuros@dreamwiz.com, www.ilovespine.com)

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