ENDOSCOPIC OPERATIVE TREATMENT OF LUMBAR DISC EXTRUSIONS

Piontkovskyi V. K., Zlativ V. P., Myronyk B. M., Dushnyi M. M.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

We analyzed data based on the study of 125 case histories of patients with pathology of the intervertebral discs of the lumbar spine, who underwent inpatient treatment at the Regional Center of Orthopedics, Traumatology and Vertebrology of the Public Healthcare Institution «Rivne Regional Clinical Hospital named after Yuriy Semenyuk» since May 2017 to August 2020. Using endoscopic transforaminal microdiscectomy, through a small approach, and with the help of special micro-instruments, extraction of intervertebral disc extrusions were performed under C-arm control. The significant advantages of surgical intervention are the ability to perform the procedure under local anesthesia, short duration of the operation, minimal trauma to soft tissues, the possibility of performing an additional foraminotomy, endoscopic visualization of intracanal structures, and early possibility of walking for patients. According to the results obtained by us, this technique is associated with a significant improvement in the quality of life of patients and a decrease in pain syndrome in the postoperative period. However, this surgical intervention must be used with a careful analysis of the anatomy of the lumbosacral spine and the absence of contraindications, since successful removal of the hernia can be difficult due to the high position of the iliac wings, fractures of the vertebral structures in the past, scoliotic deformation of the spine or significant migration of the extrusion. In addition, during or after endoscopic transforaminal microdiscectomy, the surgeon may encounter some complications such as damage to the dura mater, recurrence of extrusion or paresthesias etc. Therefore, this operative technique cannot be considered as a single standard in the operative treatment of intervertebral disc extrusions and be used routinely. However, with strict adherence to indications and contraindications during patient selection for surgical intervention, this minimally invasive technique may allow decompression of nerve structures without excessive trauma to the human body.

disc extrusion,transforaminal endoscopic microdiscectomy.

1. Mixter W, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210-5.
2. Kambin P. Arthroscopic microdiskectomy. Mt Sinai J Med. 1991;58(2):159-64.
3. Khandge AV, Sharma SB, Kim JS. The Evolution of Transforaminal Endoscopic Spine Surgery. World Neurosurg. 2021 Jan;145:643-656. 
4. Hoogland T. Transforaminal endoscopic discectomy with foraminoplasty for lumbar disc herniation. Surg Tech Orthop Surg Tech Orthop Traumatol. 2003;40(40):55-120.
5. Hoogland T, Scheckenbach C. Die endoskopische transforminale diskektomie bei lumbalen bandscheibenforfallen. Orthop Prax. 1998;34:352-5.
6. Fiorenza V, Ascanio F. Percutaneous Endoscopic Transforaminal Outside-In Outside Technique for Foraminal and Extraforaminal Lumbar Disc Herniations. Operative Technique, World Neurosurgery. 2019;130:244-53.
7. Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, et al. Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon’s training level of minimally invasive spine surgery. Clin Neurol Neurosurg. 2013 Oct;115(10):1987-91. DOI: 10.1016/ j.clineuro.2013.06.008. 
8. Hoogland T, Schubert M, Miklitz B, Ramirez A. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases . Spine. 2003;31:890-7. 
9. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33(9):931-9.
10. Huang TJ, Hsu RW, Li YY, Cheng CC. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res. 2005;23:406-11.
11. Ahn Y, Oh HK, Kim H, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery. 2014;75(2):124-33.
12. Komp M, Hahn P, Ozdemir S, Merk H, Kasch R, Godolias G, et al. Operation of lumbar zygoapophyseal joint cyst using a full – endoscopic inter-laminar and transforaminal approach: prospective 2-year results of 74 patients. Surg Innov. 2014 Dec;21(6):605-14. DOI: 10.1177/15533506145 25668.
13. Haufe SMW, Mork AR, Pyne MA, Baker RA. Endoscopic laminoforaminoplasty success rates for treatment of foraminal spinal stenosis: report on sixty-four cases. Int J Med Sci 2009;6(2):102-5. DOI: 10.7150/ijms.6.102.
14. Kambin P, Casey K, O’Brien E, Zhou L. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg. 1996;84:462- 467.
15. Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU Classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection. Eur Spine J. 2010 Jul;19(7):1087-1093.
16. Ahn Y, Kim JU, Lee BH, Lee SH, Park JD, Hong DH, et al. Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy. J Neurosurg Spine. 2009;10(6):595-602.
17. Ho JY, Lee SH, Lee HY. Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation: floating retraction technique. Minim. Invasive Neurosurg. 2011;54(5-6):214-218.
18. Tezuka F, Sakai T, Abe M, Yamashita K, Takata Y, Higashino K, et al. Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach. Spine J. 2017 Dec;17(12):1875-1880.
19. Bai J, Zhang W, Wang Y, An J, Zhang J, Sun Y, et al. Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 intervertebral disc herniation. Eur J Med Res. 2017;22:14.

«Bulletin of problems biology and medicine» Issue 4 (167), 2022 year, 193-203 pages, index UDK 616-072.1:616.711-089

10.29254/2077-4214-2022-4-167-193-203