title: Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note.
abstract: Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors' hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient's symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.
authors.affiliation: Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital; and.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Henmi
authors.affiliation: Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital; and.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Terai
authors.affiliation: Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital; and.
authors.forename: Naohito
authors.initials: N
authors.lastname: Hibino
authors.affiliation: Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital; and.
authors.forename: Shinji
authors.initials: S
authors.lastname: Yoshioka
authors.affiliation: Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital; and.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Department of Orthopedics, Tokushima University, Tokushima, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Goda
authors.affiliation: Department of Orthopedics, Tokushima University, Tokushima, Japan.
authors.forename: Fumitake
authors.initials: F
authors.lastname: Tezuka
authors.affiliation: Department of Orthopedics, Tokushima University, Tokushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sairyo
keywords: HNP = herniated nucleus pulposus; MED = microendoscopic discectomy; PED = percutaneous endoscopic discectomy; epidural observation; foraminoplasty; herniated nucleus pulposus; percutaneous endoscopic lumbar discectomy