ABSTRACT
BACKGROUND: Minimally invasive spine surgery (MISS) represents a major development in spinal tumor surgery. However, considering that many intradural lesions compromise multiple spinal segments, MISS has certain limitations. Thus, some intraspinal lesions still require traditional approaches. Because laminectomy has been shown to predispose patients to kyphosis, laminoplasty and hemilaminectomy are the most widely used approaches to preserve the posterior tension band (PTB). However, these techniques are not devoid of complications. To overcome these issues, the authors modified a previously described technique to preserve the PTB while removing various types of intradural lesions. This procedure was originally designed to treat lumbar stenosis and was modified to avoid muscle ischemia during long procedures. OBSERVATIONS: Between 2014 and 2021, the authors found 17 cases of spinal lesions with a minimum of 2 years of follow-up after surgical treatment using their approach. No significant postoperative changes in the paraspinal Goutallier grade or spinal angles were observed. The cross-sectional area of the measured paraspinal muscles decreased 6% postoperatively. By performing certain technical modifications in this PTB-sparing (PBS) laminectomy, the authors avoided ipsilateral muscle ischemia. LESSONS: In this initial series, PBS laminectomy proved to be a safe, versatile, inexpensive, and reliable technique to remove intraspinal lesions.
ABSTRACT
La Discectomía Percutánea Endoscópica Lumbar es una técnica mínimamente invasiva para el tratamiento de las hernias discales lumbares con resultados comparables a la microdiscectomía lumbar. La principal complicación, los fragmentos discales remanentes, son en gran parte producidos por la limitación de movimiento del endoscopio una vez realizada la punción. Presentamos una nota técnica y aplicación en un caso ejemplo de lo que hemos llamado "libre flotación foraminal": un acceso al espacio epidural por vía transforaminal que mantiene la libertad de movimiento y permite una exploración endoscópica en busca de fragmentos remanentes.
Percutaneous endoscopic lumbar discectomy is a minimally-invasive surgical approach for the treatment of lumbar disc herniation, with outcomes similar to open micro-discectomy. The main complication residual disc fragments is largely caused by a rigid endoscopic trajectory once the puncture has been made. We present a technical note of a surgery performed in a patient who underwent what we have called a "free foraminal flotation technique": accessing the epidural space through a transforaminal approach that maintains freedom of movement and allows for endoscopic exploration to locate residual disc fragments.
