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*
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). 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. 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). 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. 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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