Transpedicular Lumbar Endoscopic Surgery for Highly Migrated Disk Extrusions: Preliminary Series and Surgical Technique.

OBJECTIVE: Endoscopic surgery for highly migrated lumbar disk extrusions is a challenge even for spine surgeons who are familiar with using endoscopic techniques. Because of the anatomic constraints involved in transforaminal access in endoscopic surgery, an incomplete removal of a highly migrated disk extrusion can result in some cases. Here the authors describe a new technique for accessing extruded lumbar disks that have migrated into the canal directly through a transpedicular approach.

METHODS: A technique for the endoscopic treatment of highly migrated lumbar disk extrusions is presented. Retrospectively, we reviewed a series of 21 consecutive patients operated on with lumbar 3-4, lumbar 4-5, and lumbar 5-sacral 1 highly migrated disk extrusions: preoperative and postoperative clinical data with 1-year follow-up.

RESULTS: A preliminary series of 11 male and 10 female patients with an average age of 56.9 years (from 33-78 years old) who underwent transpedicular endoscopic retrieval of an extruded lumbar disk between 2012 and 2015 is presented. Two patients required revision to transforaminal access, 1 at the same sitting and the other 4 weeks later. The mean visual analog scale score for radicular pain improved from an average pain score before surgery of 8.1-1.7 one year after surgery. No pedicle fractures were encountered.

CONCLUSIONS: Transpedicular endoscopic access to highly migrated lumbar herniated disk extrusions is presented as a unique minimally invasive approach to extruded lumbar herniated disks, especially at L3-4, L4-5, and L5-S1.