title: Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations.
  
  
  METHODS
  The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach.
  
  
  RESULTS
  The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases.
  
  
  CONCLUSIONS
  In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.
authors.affiliation: Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
authors.forename: Ki Hwan
authors.initials: KH
authors.lastname: Chae
authors.forename: Chang Il
authors.initials: CI
authors.lastname: Ju
authors.forename: Seung Myung
authors.initials: SM
authors.lastname: Lee
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Kim
authors.forename: Saeng Youp
authors.initials: SY
authors.lastname: Kim
authors.forename: Hyeun Sung
authors.initials: HS
authors.lastname: Kim