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CASE REPORT
Year : 2018  |  Volume : 32  |  Issue : 2  |  Page : 116-122

Percutaneous endoscopic interlaminar lumbar discectomy for high-grade inferiorly migrated L5-S1 disc: A case report with technical review

Manish Raj1, Hyeun S Kim2, Kailash Kothari3, Anurag Agarwal4, Santosh Tripathi5, Shobhit Bharadwaj6
1 Department of Interventional Spine and Pain Medicine, Yatharth Super Speciality Hospital, Noida, India
2 Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
3 Department of Interventional Spine and Pain, Pain Clinic of India, Mumbai, India
4 Department of Anaesthesiology and Pain Management, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
5 Department of Neuroscience, Metro Neuro Hospital, Gwalior, India
6 Department of Orthopedic Surgery, Yatharth hospital, Noida, India

Correspondence Address:
Dr. Manish Raj
Department of Interventional Spine and Pain Medicine, Yatharth Super Speciality Hospital, Sector 110, Noida, Uttar Pradesh,
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpn.ijpn_25_18

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L5-S1 disc has always been a difficult disc to target by rigid endoscope because of anatomical limitations. In this study, we have described the technique to overcome difficulty faced during endoscopic disc decompression of high-grade inferior migrated disc at L5-S1. We performed percutaneous endoscopic inter-laminar lumbar discectomy (PEILD) for removal of high grade inferiorly migrated disc and preserved the functional structures. After institutional review board approval, details of the patient with high-grade inferior migration at L5-S1 disc were reviewed. The patient was operated by a single specialist with use of the percutaneous endoscopic inter-laminar technique for high-grade inferior migrated extruded disc. Description of our technique & result is the focus of this study. The average VAS score was reduced from 9 pre-operatively to 3 post-operatively & to 1-2 within 2 weeks. Post-operative plantar flexion of foot improved from 2 to 4 immediately and up to 5 within 2 weeks. Ankle jerk reflex improved from 1+ to 2+. The pain severity score on BPI reduced from 9 to 3 postoperatively. Post-operative MRI showed that the high grade inferiorly ruptured disc had been successfully removed. We obtained excellent results in treating inferior extruded disc at L5-S1 using endoscopic inter-laminar approach. Inter-laminar endoscopic discectomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a high grade inferior migrated lumbar disc herniation.


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Online since 31 May, 2013