Cargando…

The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach

BACKGROUND: Surgery for same level multi-focal extruded lumbar disc herniations is technically challenging and the optimal method controversial. The subarticular disc herniation may pose the most challenging subtype requiring partial or complete facetectomy with or without fusion. The far-lateral di...

Descripción completa

Detalles Bibliográficos
Autores principales: Yue, James J., Scott, David L., Han, Xiao, Yacob, Alem
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Society for the Advancement of Spine Surgery 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325509/
https://www.ncbi.nlm.nih.gov/pubmed/25694941
http://dx.doi.org/10.14444/1016
_version_ 1782356816814931968
author Yue, James J.
Scott, David L.
Han, Xiao
Yacob, Alem
author_facet Yue, James J.
Scott, David L.
Han, Xiao
Yacob, Alem
author_sort Yue, James J.
collection PubMed
description BACKGROUND: Surgery for same level multi-focal extruded lumbar disc herniations is technically challenging and the optimal method controversial. The subarticular disc herniation may pose the most challenging subtype requiring partial or complete facetectomy with or without fusion. The far-lateral disc herniation, often treated using a Wiltse approach, can also be difficult to access especially in the obese patient. When both the subarticular and far-lateral subtypes are simultaneously present at the same level with or without a paracentral disc herniation, a total facetectomy and interbody fusion (TLIF) or a total disc replacement (TDR) may be necessary. Endoscopic surgical techniques may reduce the need for these more invasive methods. METHODS: Fifteen patients (6 male and 9 female) who had same level multi-focal (subarticular as well as far-lateral and/or paracentral) extruded disc herniations underwent single incision unilateral endoscopic disc excision by the same surgeon at a single institution. Patients were prospectively followed for an average of 15.3 months (range 14-18 months) and outcomes were evaluated radiographically and clinically (Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). RESULTS: The mean operative time was 52 minutes with minimal blood loss in all cases. Fourteen of the 15 patients were discharged to home on the day of their surgery. The mean ODI and leg VAS scores improved from 22.9 ± 3.2 to 12.9 ± 2.7 (p < 0.005), and from 8.6 ± 1.6 to 2.1 + 0.4 (p < 0.005), respectively. CONCLUSIONS: After an average of 15.3 months of follow-up, the clinical and radiographic results of full endoscopic surgical treatment of single level multi-focal (subarticular as well as far-lateral and/or paracentral) disc herniations are excellent. This study is a case series with mid-term follow-up (Level IV). CLINICAL RELEVANCE: Foraminal and extra-foraminal full endoscopic decompression appears to offer a safe minimally invasive solution to a complex pathologic problem.
format Online
Article
Text
id pubmed-4325509
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher International Society for the Advancement of Spine Surgery
record_format MEDLINE/PubMed
spelling pubmed-43255092015-02-18 The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach Yue, James J. Scott, David L. Han, Xiao Yacob, Alem Int J Spine Surg Article BACKGROUND: Surgery for same level multi-focal extruded lumbar disc herniations is technically challenging and the optimal method controversial. The subarticular disc herniation may pose the most challenging subtype requiring partial or complete facetectomy with or without fusion. The far-lateral disc herniation, often treated using a Wiltse approach, can also be difficult to access especially in the obese patient. When both the subarticular and far-lateral subtypes are simultaneously present at the same level with or without a paracentral disc herniation, a total facetectomy and interbody fusion (TLIF) or a total disc replacement (TDR) may be necessary. Endoscopic surgical techniques may reduce the need for these more invasive methods. METHODS: Fifteen patients (6 male and 9 female) who had same level multi-focal (subarticular as well as far-lateral and/or paracentral) extruded disc herniations underwent single incision unilateral endoscopic disc excision by the same surgeon at a single institution. Patients were prospectively followed for an average of 15.3 months (range 14-18 months) and outcomes were evaluated radiographically and clinically (Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). RESULTS: The mean operative time was 52 minutes with minimal blood loss in all cases. Fourteen of the 15 patients were discharged to home on the day of their surgery. The mean ODI and leg VAS scores improved from 22.9 ± 3.2 to 12.9 ± 2.7 (p < 0.005), and from 8.6 ± 1.6 to 2.1 + 0.4 (p < 0.005), respectively. CONCLUSIONS: After an average of 15.3 months of follow-up, the clinical and radiographic results of full endoscopic surgical treatment of single level multi-focal (subarticular as well as far-lateral and/or paracentral) disc herniations are excellent. This study is a case series with mid-term follow-up (Level IV). CLINICAL RELEVANCE: Foraminal and extra-foraminal full endoscopic decompression appears to offer a safe minimally invasive solution to a complex pathologic problem. International Society for the Advancement of Spine Surgery 2014-12-01 /pmc/articles/PMC4325509/ /pubmed/25694941 http://dx.doi.org/10.14444/1016 Text en Copyright © 2014 ISASS - International Society for the Advancement of Spine Surgery http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Article
Yue, James J.
Scott, David L.
Han, Xiao
Yacob, Alem
The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach
title The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach
title_full The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach
title_fullStr The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach
title_full_unstemmed The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach
title_short The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach
title_sort surgical treatment of single level multi-focal subarticular and paracentral and/or far-lateral lumbar disc herniations: the single incision full endoscopic approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325509/
https://www.ncbi.nlm.nih.gov/pubmed/25694941
http://dx.doi.org/10.14444/1016
work_keys_str_mv AT yuejamesj thesurgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT scottdavidl thesurgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT hanxiao thesurgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT yacobalem thesurgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT yuejamesj surgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT scottdavidl surgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT hanxiao surgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach
AT yacobalem surgicaltreatmentofsinglelevelmultifocalsubarticularandparacentralandorfarlaterallumbardischerniationsthesingleincisionfullendoscopicapproach