Percutaneous Endoscopic Lumbar Discectomy Technique For The Treatment Of Highly Migrated Lumbar Disc Herniation Via Contralateral Transforaminal Approach

Objective：A retrospective research of the safety and feasibility ofpercutaneous endoscopic lumbar discectomy(PELD) technique for thetreatment of highly migrated lumbar disc herniation via contralateraltransforaminal approach.Methods：A retrospective research was performed of12consecutivepatients who underwent the surgery for the treatment of highly migratedlumbar disc herniation via this approach from february2010to february2012. There were3patients at L3/4level and9patients at L4/5level.Patient’s intraoperative response and tolerance were observed. Operationtime and postoperative complications were recorded.Patients wereevaluated by the Visual Analog Scale(VAS) and Oswestry DisabilityIndex(ODI) scores. Outcomes were graded according to modified Macnabcriteria.Results：All the patients tolerated the procedure without specialcomplaints. The mean operation time was110±20.05min. All the patients were followed-up12～24months, the mean follow-up time was18months.The VAS for radicular pain improved from7.75±0.97preoperationto2.42±0.79postoperation, and to1.42±0.79at12monthspostoperation.The mean ODI scores improved from57.67±9.57preoperation to8.50±3.73at12months postoperation.The pain and dailylife function improved obviously postoperation.Based on modified Macnabcriteria,91.67％(11/12)of patients experienced satisfactory outcome. Thedata showed that excellent in8patients, good in3patients, fair in1patients and no poor. One patient in fair group was not satisfied withoutcome.The symptom of the coccygeal nerve injury postoperationincreased. Nevertheless,the symptom relieved after3moonths conservativetreatment.Conclusion：The technique of PELD via contralateral transforaminalapproach was a supplementary approach of PELD for treating Lumbar discherniation, especially for highly migrated Lumbar disc herniation. It was asafe and feasible operation approach.