Juniper Publishers | Journal of Head Neck & Spine Surgery

Posterolateral Percutaneous Endoscopic Discectomy with Partial Pediculotomy for the L1-L2 High-Grade Downward Migrated Disc Herniation



Authored by Yoshihiro Kitahama

Background: Percutaneous endoscopic discectomy (PED) is one of the most useful minimally invasive surgical techniques for lumbar disc herniation (LDH). However, high-grade migrated disc is difficult to treat with only the standard posterolateral approach (posterolateral PED, PLPED).
Purpose: To overcome this difficulty, we combined the pediculotomy with PLPED for the treatment of high-grade migrated LDH. The pediculotomy is the recent technic for PED that has been explored with development of high-speed drill.
Case report: A 72-year-old man had a 6-month history of left L2 radiculopathy. His general state was too poor to perform general anesthesia and invasive surgery. The left L1-L2 downward migrated fragment compressed his L2 nerve root axial portion on magnetic resonance imaging. PLPED with partial pediculotomy was used for complete total removal, which cured his symptoms without any complications. Thirty minutes after fragmentectomy, we needed to control 100-ml bleeding from the anterior epidural venous plexus (AEVP).
Discussion: Upper-level migrated large lumbar disc fragments often require facetectomy with some fusion in conventional microscopic surgery. This case was too complicated for indicating the conventional technique. Only the flexible bipolar device helps control hemostasis in the PED system, but some bleeding cannot be controlled easily.
Conclusion: PLPED with partial pediculotomy was useful for a migrated fragment in patients with poor general conditions. Although the PED system requires a new device to control the bleeding from the AEVP.

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