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How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy

  • How I Do it - Spine degenerative
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Abstract

Background

Although percutaneous endoscopic lumbar discectomy (PELD) has been popularized as an alternative to microscopic lumbar discectomy, it has been reported to be associated with a re-herniation rate of 5–11%. Recurrent lumbar disc herniation (RLDH) might occur not only at the same level previously operated upon but also at the annular penetration site created during PELD procedures.

Method

Biportal endoscopic paraspinal approach (BE-Para) was used for revisional foraminal lumbar discectomy. Procedures and some discussions regarding indications, advantages, potential complications, and ways to avoid complications were described.

Conclusion

BE-Para may be an effective modality for RLDH after PELD.

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Acknowledgements

The authors appreciate the Editage (www.editage.co.kr) for English language editing.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Inchonro 73, Seongbukgu, Seoul, 02841, Republic of Korea

    Sung Cheol Park, Min-Seok Kang, Jae Hyuk Yang & Wonjik Ju

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  1. Sung Cheol Park
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  2. Min-Seok Kang
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  3. Jae Hyuk Yang
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  4. Wonjik Ju
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Contributions

SCP, JHY, WJJ, and MSK contributed to the conception of the study. SCP and MSK wrote the manuscript. JHY and WJJ reviewed the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Min-Seok Kang.

Ethics declarations

Ethics approval

This study protocol was approved by the Institutional Review Board (IRB file no.: BMH 2022–03-024) and adhered to the guidelines of the Declaration of Helsinki.

Consent to participate

Not applicable.

Conflict of interest

The authors declare no competing interests.

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Key points

I. BE-Para is a minimally invasive alternative to conventional microscopic technique that provides some advantages such as tissue sparing and minimal blood loss.

II. The annular defect created by cannular penetration during PELD might be a route for RLDH.

III. Despite some concerns regarding the revision surgery, BE-Para is a viable option for the revisional foraminal lumbar discectomy.

IV. Two independent 0.8-cm-sized vertical incisions should be made at 2 cm lateral to the lateral margin of the pedicle over the midportion of the transverse processes of adjacent vertebrae.

V. When dissecting and removing the facet joint capsule from the isthmus, attention should be paid to prevent severe bleeding because the articular branch of lumbar radicular artery passes inside the joint capsule.

VI. The portion where the exiting root originates from the dural sac should be secured before adhesiolysis to avoid root injury, because the fibrotic scar tissue is usually not seen at this site.

VII. Blunt dissection starts from the origin of the root and should advance peripherally using a dissector.

VIII. When working around the exiting nerve root, care should be taken to avoid damaging dorsal root ganglion, which is sensitive to the neuropathic pain.

IX. Lifestyle modifications, such as regular walking, blood sugar control, cessation of smoking, and weight reduction, are as necessary as meticulous surgical techniques.

X. BE-Para discectomy, a non-fusion technique, for the recurrent disc herniation, might have the risk of re-recurrent disc herniation requiring a third surgery.

This article is part of the Topical Collection on Spine Degenerative

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Park, S.C., Kang, MS., Yang, J.H. et al. How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy. Acta Neurochir 164, 3057–3060 (2022). https://doi.org/10.1007/s00701-022-05368-7

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  • DOI: https://doi.org/10.1007/s00701-022-05368-7

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