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Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika)

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Percutaneous endoscopic transforaminal and interlaminar lumbar discectomy for cranially migrated disc hernia

https://doi.org/10.14531/ss2020.3.81-90

Abstract

Objective. To evaluate clinical outcomes, safety, and technical peculiarities of percutaneous endoscopic transforaminal and interlaminar removal of the lumber spine cranially migrated disc hernias.

Material and Methods. In 2015–2018, percutaneous endoscopic transforaminal and interlaminar removal of cranially migrated hernias of the lumbar spine was performed in 53 patients (23 men and 30 women): 2 (3.8 %) at L2–L3 level, 13 (24.5 %) at L3–L4, 18 (34.0 %) at L4–L5, and 20 (37.7 %) at L5–S1. The age of patients ranged from 25 to 76 years and averaged 43.4 ± 11.6 years. Transforaminal approach was performed at the L4–L5 level and higher (62.3 % of cases), and interlaminar approach – at the L5–S1 level (37.7 %). Based on MRI, hernias with cranial migration were divided into zones: zone I – hernias with migration to the lower edge of the superjacent vertebra pedicle – 21 (39.6 %) patients; and zone II – hernias with migration above this border – 32 (60.4 %). Results were evaluated using ODI, VAS, and the McNab scale. Statistical analysis of VAS indicators (leg and back pain) and ODI scores before and after surgery was performed using the R and Microsoft Excel 2007 software.

Results. Data collection was carried out using patient questionnaires at in-person examination, telephone interviews and electronic communications. Follow-up data of different terms were monitored in all patients. In one case (when mastering this technology), at the second stage, microdiscectomy was performed at the L4–L5 level for a residual hernia fragment in migration zone II, and in another case, a conversion into microdiscectomy was performed at L3–L4 level with a hernia in zone II due to lack of venous bleeding control in a patient receiving anticoagulants. In other patients, the mean VAS scores of preoperative radicular and axial pain decreased from 7.5 ± 1.4 and 3.8 ± 1.2 to 1.4 ± 1.2 and 3.5 ± 1.3, respectively, on the next day, to 1.7 ± 1.4 and 3.2 ± 1.1 in 1 month, to 1.5 ± 1.3 and 2.8 ± 1.4 in 6 months, to 1.6 ± 1.2 and 2.0 ± 1.3 in 12 months, and to 1.6 ± 1.2 and 2.0 ± 1.3 in 24 months after surgery. In the long-term follow-up period, no radicular leg pain was observed in any patient. According to the McNab scale, up to 6 months treatment results were assessed as excellent by 19 (35.8 %) patients, and as good – by 32 (60.3 %). In the case of lumbar pain in the long term period, blockade of facet joints and radiofrequency ablation of the medial nerve branch were performed. Relapse of hernias and instability of the operated spinal segment were not revealed. The average ODI score improved from 66.4 ± 7.2 to 20.5 ± 3.2 in 1 month, to 13.6 ± 2.1 in 6 months, to 12.4 ± 2.3 in 12 months, and to 12.4 ± 2.3 in 24 months after surgery.

Conclusion. Percutaneous endoscopic transforaminal and interlaminar discectomy for cranially migrated lumbar disc hernia, while adhering the surgical technique target and exclusion criteria, is a safe and effective method, avoids excessive resection of the bone-ligamentous structures of the spine, can prevent iatrogenic instability of the spinal motion segment, and promotes early postoperative activation and recovery of the patient. Cranially migrated disc henias have a low probability of recurrence.

About the Authors

A. M. Meredzhi
Polenov Neurosurgical Research Institute; Multidisciplinary Clinic n.a. N.I. Pirogov
Russian Federation

Amir Muratovich Meredzhi, MD, PhD, senior res  earcher at the Research Laboratory of Neurosurgery of the spine and peripheral nervous system, neurosurgeon

12 Mayakovskogo str., St. Petersburg, 191014;

49–51 Bolshoi Prospect, Vasilievsky Island, St. Petersburg, 199178



A. Yu. Orlov
Polenov Neurosurgical Research Institute
Russian Federation

Andrey Yuryevich Orlov, DMSc, head of the Research Laboratory of Neurosurgery of the spine and peripheral nervous system, neurosurgeon

12 Mayakovskogo str., St. Petersburg, 191014



A. S. Nazarov
Polenov Neurosurgical Research Institute
Russian Federation

Alexandr Sergeyevich Nazarov, MD, PhD, senior researcher of the Research Laboratory of Neurosurgery of the spine and peripheral nervous system, head of the Department of neurosurgery of the spine and peripheral nervous system, neurosurgeon

12 Mayakovskogo str., St. Petersburg, 191014



Yu. V. Belyakov
Polenov Neurosurgical Research Institute
Russian Federation

Yury Vladimirovich Belyakov, researcher, Research Laboratory of Neurosurgery of the spine and peripheral nervous system, neurosurgeon

12 Mayakovskogo str., St. Petersburg, 191014



T. V. Lalayan
Multidisciplinary Clinic n.a. N.I. Pirogov
Russian Federation

Tigran Vladimirovich Lalayan, MD, PhD, neurologist

49–51 Bolshoi Prospect, Vasilievsky Island, St. Petersburg, 199178



S. B. Singaevskiy
Multidisciplinary Clinic n.a. N.I. Pirogov
Russian Federation

Sergey Borisovich Singaevskiy, DMSc, surgeon, physician-in-chief of Multidisciplinary Clinic n.a. N.I. Pirogov

49–51 Bolshoi Prospect, Vasilievsky Island, St. Petersburg, 199178



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Review

For citations:


Meredzhi A.M., Orlov A.Yu., Nazarov A.S., Belyakov Yu.V., Lalayan T.V., Singaevskiy S.B. Percutaneous endoscopic transforaminal and interlaminar lumbar discectomy for cranially migrated disc hernia. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(3):81-90. https://doi.org/10.14531/ss2020.3.81-90



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ISSN 1810-8997 (Print)
ISSN 2313-1497 (Online)