A Modified Extreme Lateral Access In PELD For Central Herniation Of Upper Lumbar Vertebra With Blunt Guide Rod: A Cadaveric Study And Clinical Case Reports

Background: Due to unique anatomy of upper lumbar vertebra, conventional access in PELD via guide wire and needle had multiple drawbacks regarding iatrogenic abdominal visceral injury and carried potential risk of injury to spinal canal. New alteration or variation in technique was needed over time.Objective: A feasibility study of a novel trajectory pathway that was designed in extreme lateral access to overcome those risks.Methods: One cadaveric study was performed in our setup to test practicability of this technique. The clinical study included eight patients manifested with low back pain and ill-defined radiculopathies due to central herniated disc of upper lumbar who were treated with extreme lateral excess PELD with modified trajectory via blunt guide rod. Preoperative prone abdomen CT image was taken to assure the trajectory pathway and intraoperative C- arm intensifiers were obtained to determine the point of entry and target points. The three target points were iliocostalis lumburom muscle, facet joint and superior ventral notch of adjacent vertebra respectively. Blunt guide rod of tip diameter 3.0mm and 5.0mm body diameter was used in procedure.Results: No major surgery related complications were encountered. The patients experienced relief of symptoms and the immediately postoperative MR image showed complete removal of herniated disc. The clinical outcome were evaluated using Visual analogue scale(VAS) and Oswestry Disability index(ODI) and the findings was significant.Conclusion: This procedure seems more effective and affordable procedure. It is simple but an appropriate.Limitation. Study has relatively a small sample size and short follow up period.