title: Percutaneous endoscopic lumbar discectomy and annuloplasty for lumbar disc herniation at the low two contiguous levels: single-portal, double surgeries.
abstract: METHODS
  Technical case report.
  
  
  OBJECTIVE
  The authors report surgical experience of treating contained or noncontained lumbar disc herniation (LDH) at the L3-L4 and L4-L5 or L4-L5 and L5-S1 levels by transforaminal percutaneous endoscopic lumbar discectomy and annuloplasty (PELDA) through the single entry point.
  
  
  BACKGROUND
  When there are concurrent LDHs involving lower two levels simultaneously, PELDA has not been performed.
  
  
  METHODS
  Between March 2008 and May 2011, eight patients presented with back pain or radicular lower limb pain. Upon radiologic examination using magnetic resonance imaging, the patients were diagnosed with central or paramedian LDH at low spine levels (L3-L4 and L4-L5 or L4-L5 and L5-S1) consistent with their clinical presentations. We performed double PELDA at the affected two levels simultaneously through a single skin portal.
  
  
  RESULTS
  The symptoms were relieved dramatically, and all patients were discharged the next day. There was no radiologic instability during the follow-up period.
  
  
  CONCLUSIONS
  Transforaminal PELDA to treat two levels of LDH through a single portal could be considered as one of the minimally invasive treatment modalities that avoids conventional open surgery.
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Jung-Woo
authors.initials: JW
authors.lastname: Hur
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Jin-Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Myung-Hoon
authors.initials: MH
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Kyeong-Sik
authors.initials: KS
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Chun-Kun
authors.initials: CK
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D001416:Back Pain / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult