Percutaneous endoscopic lumbar discectomy with two-segment foraminoplasty in a single incision for the treatment of very-highly migrated lumbar disc herniation: a retrospective study

Abstract Background Surgical treatment for very-highly migrated lumbar disc herniation ( (VHM-LDH)) is challenging. In this study we introduced the percutaneous transforaminal endoscopic lumbar discectomy (PtELD) with two-segment foraminoplasty technique and evaluated it’s clinical outcomes. Materials and Methods Between Jan 2017 to Dec 2020, patients who were diagnosed with VHM-LDH underwent PtELD with two-segment foraminoplasty technique were retrospectively studied. The cranial and caudal foraminoplasty of two adjacent vertebrae were performed under endoscopic view to fully expose and decompress the whole traversing course of the impinged nerve root and the axilla between dural sac and nerve root. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. Immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results A total of 33 patients with mean age of 56.87 ± 7.77 years were reviewed. The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation duration and blood loss was 56.17 ± 6.21 min and 10.57 ± 6.92 ml, respectively. All patients showed immediate relief of neurological symptom after surgery. No residual disc fragments and iatrogenic instability was observed on postoperative imageological image. The VAS and ODI score were significantly improved at the final follow-up ( p < 0.05). The postoperative complications, recurrences, revision surgery and iatrogenic instability were not observed. Conclusions The PtLED with two-segment foraminoplasty technique is safe and effective in the management of VHM-LDH. The surgeon should master skillful endoscopic foraminoplasty technique to avoid inadvertent over-resection of SAP/pedicle, and iatrogenic neurological injury.