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Year : 2018  |  Volume : 32  |  Issue : 3  |  Page : 125-131

Full-endoscopic lumbar discectomy for high canal compromised disc at upper lumbar level: A technical review

1 Department of Interventional Spine and Pain, Yatharth Hospital, Noida, Uttar Pradesh, India
2 Department of Interventional Spine and Pain, Pain Clinic of India, Mumbai, Maharashtra, India
3 Department of Anesthesiology and Pain Medicine, Dr. RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
4 Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
5 Department of Interventional Spine and Pain, IPSC, Delhi, India
6 Department of Orthopedic Surgery, Yatharth Hospital, Noida, Uttar Pradesh, India
7 Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
8 Department of Interventional Spine, Centrul Provita Hospital, Bucharest, Romania

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

DOI: 10.4103/ijpn.ijpn_51_18

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Objective: In this study, we have described the technique to overcome difficulty faced during trans-foraminal endoscopic discectomy for the treatment of lumbar radiculopathy in patients who have herniated discs at the upper lumbar level & thoracolumbar junction. Method: After institutional review board approval, A retrospective analysis of 27 patients operated between March 2013- September 2017, by a single specialist for disc herniation at upper lumbar levels D12-L1, L1-2, L2-3 with or without high canal compromise by outside in technique (using rigid endoscope, sequential reamers) along with detailed description of our technique is the focus of this study. Results: Out of 27 patients there were 11 cases for L1-2 & 16 cases of L2-3 disc herniation respectively. There were 21 cases of broad-based, high canal compromised disc herniation with significant neurological deficit & only 6 cases were of focal herniation type. The average preoperative VAS score of 8.5 (range 6-10) reduced to 4 (range 2-7) immediate postoperatively & it further reduced to 2 (range 0-4) at one month follow up. The average preoperative ODI score of 65 (range 28- 88) reduced to 27 (range 12-40) immediate postoperatively & it further reduced to 10 (range 3- 18) at one month follow up. Post-operative MRI showed that the ruptured disc had been successfully removed. Conclusion: An anatomically modified surgical technique promote a more successful outcome after percutaneous endoscopic discectomy for upper lumbar disc herniation. Foraminotomy is recommended for all intra-canalicular herniation. Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of an upper lumbar disc herniation.

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