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Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) on treatment of far lateral lumbar disc herniation (FLDH). Methods We retrospectively analyzed 27 patients with FLDH underwent percutaneous endoscopic lumbar discectomy from June 2014 to September 2015, age from 41 to 64, average 52.3. The average operation time, intraoperative blood loss and length of hospital stay were collected. The lumbocrural pain perception of patients before and after surgery was assessed by visual analog scale (VAS) and postoperative lumbar functional recovery after surgery by modified MacNab criteria. Results Average operation time was 69 min (58~109 min), intraoperative blood loss was 18 ml (11~40 ml), and length of stay was 5.0 d (3.0 ~ 10.0 d). VAS score from (8.12 ± 1.25) preoperatively improved to (2.80 ± 1.12) at the 3rd d after operation, (1.59 ± 1.06) at 3 months after operation, and (1.31 ± 0.89) at the last follow-up after operation; There was a statistical difference between preoperative scores and postoperative scores (P < 0.05). Modified MacNab criteria was a ratio of 88.9%. Conclusions PELD on the treatment of far lateral lumbar disc herniation have small area of trauma, faster postoperative recovering and several other advantages,which is a safe and effective minimally invasive surgery.
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Objective To explore the clinical effect of the elderly far lateral lumbar disc herniation via Quadrant channel system under the Wiltse approach. Methods Thirty-three elderly patients suffering from far lateral lumbar disc herniation were treated by surgery, among whom 18 patients were treated by Quadrant minimally invasive channel system (Quadrant group), and 13 patients were treated by percutaneous transforaminal endoscopic discectomy (PTED group). The patients were followed up for 12 months, and the operation time, blood loss and length of incision were investigated. The JOA scores were compared preoperatively and postoperatively. Results The patients in two groups were followed up for 24 months, except 1 patient withdrew in Quadrant group. The incision length and blood loss in PTED group were superior to those in the Quadrant group:2.0-2.5 cm vs. 0.7 cm, (46.50± 15.20) ml vs.(23.87±6.58) ml, P0.05). Conclusion Surgical treatment on elderly far lateral lumbar disc herniation via quadrant channel under wiltse approach is an effective method, and can achieve similar effect with PTED.
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The concept of far lateral lumbar disc herniation was firstly reported by Abdullah in 1974. The diagnosis of far lateral lumbar disc herniation is based on the discography findings as well as on clinical manifestations. Far lateral lumbar disc herniation is a special type of lumbar disc herniation. Clinically, far lateral lumbar disc herniation is less seen than other types of lumbar disc herniation, it accounts for 0.7%-11.7% of total lumbar intervertebral disc protrusion. Although the incidence of far lateral lumbar disc herniation is lower, its symptoms are usually heavier and its protrusion sites are specific. Its treatment methods are more complex, including mainly conservative treatment, minimally invasive interventional therapy and surgical management, etc. This paper aims to make a review about the recent progress in its corresponding treatment.
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OBJECTIVE: There are few reports on the clinical outcomes of the percutaneous endoscopic lumbar discectomy(PELD) with laser for the treatment of far lateral lumbar disc herniation. The objective of this study is to assess the safety and efficacy of the PELD with laser for the treatment of far lateral lumbar disc herniation. METHODS: The clinical records of 42 patients who had far lateral lumbar disc herniation and underwent PELD with laser between January 1996 and August 2002 were analyzed retrospectively. There were 24(57.1%) males and 18(42.9%) females, with a mean age of 53(range, 26-73) years. The surgical procedure was performed via a posterolateral approach after induction of a local anesthesis. The clinical outcomes were measured with MacNabO s criteria. The mean follow-up period was 38(range, 5-77) months. RESULTS: Clinical outcomes were revealed as follows: excellent in 28 patients(66.7%); good in 11(26.2%); fair in 2(4.7%); and poor in 1(2.4%). Therefore, the percentage of successful(excellent and good) outcomes was 92.9%. There was no statistically significant variation in the success rates according to age and operation level(p>0.05). Before the introduction of the high resolution endoscope, the success rate was 90.3% but after upgrading to the high resolution endoscope, the success rate was 100%, and there was a statistically significant variation in the success rate(p<0.05). In all cases, there was no complication or recurrence. CONCLUSION: As a minimally invasive surgery, PELD with laser is a safe and efficacious procedure for the treatment of far lateral disc herniation.
Subject(s)
Female , Humans , Male , Diskectomy , Endoscopes , Follow-Up Studies , Recurrence , Retrospective Studies , Minimally Invasive Surgical ProceduresABSTRACT
The far lateral lumbar disc herniation occurs ten times less often than the classic posterolateral disc herniations. Its clinical presentation, the anatomy involved, and difficulty of surgical treatment are not well understood. The surgical approach and results also have not been clearly defined. Although there are limited number of reports and series in the literature, there is still no general consensus on the approach to surgical treatment. However, chymopapain, even with a history of controversy and troubling complications, has endured the test of time to show 30 years of clinical success in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and efficacy of treatment. Between 1984 and 1997, we treated with chymopapain injection in 69 patients with severe lumbar radiculopathy secondary to far lateral disc herniation. Average patient age was 38.5 years in the 47 male and 22 female patients involved. The L4-5 disc was the most commonly herniated level(44.9%) followed by L3-4(37.8%), L5-S1(13.0%), and L2-3(4.3%). They were assessed using standardized forms as well as the Mcnab classification and questioner. They were reviewed at an average of 5 years 8 months postoperatively. Relief of symptoms was obtained in 63 patients(91.3%) after injection. No one subsequently relapsed requiring operation. All 69 patients available for long-term follow-up had considerable and sustained relief from their symptoms. For ADL(activity of daily living), 50 patients(81.3%) answered that they had no limitation, and regarding the office or house work, 49 patients(71.0%) returned previous work without any difficulties. Based on these findings we recommend the chymopapain injection as the primary treatment for patients with severe radiculopathy secondary to far lateral herniation of a lumbar disc.