18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Central Transforaminal L2-L3 Protrusion
10.1055/b-0034-82098
18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Central Transforaminal L2-L3 Protrusion
Clinical Findings
A patient presented with left lateral thigh and leg pain for 3 weeks.
VAS was 9/10 for left leg pain and 3 to 4/10 for back pain.
Sagittal and axial MRI and CT scan showed a soft central disk herniation at the L2-L3 level (Fig. 18.27).
Preoperative Plan
The skin entry point is selected by drawing various lines as shown in the axial MRI scan, and the distance from midline is ~10 cm (Fig. 18.28). This point is more lateral from the midline than in the case of a paramedian disk herniation of L2-L3.
Fig. 18.23 AP (A) and lateral (B) fluoroscopic views of the correct positioning of the working cannula.Fig. 18.24 Intraoperative endoscopic views (12 o’clock is dorsal, 3 o’clock is cranial, 6 o’clock is ventral, 9 o’clock is caudal). (A) The blue-stained herniated fragment (arrow) can be seen on introduction of the endoscope. (B) The endoscopic forceps can be seen as the herniated fragment is removed. (C) The ligamentum flavum and annular covering of the herniated nucleus pulposus are removed with the laser. (D) Endoscopic view and illustration after the herniated disk mass is removed. EV, epidural vein.Fig. 18.25 Fluoroscopic view of the endoscopic forceps as the herniated fragment is removed.Fig. 18.26(A) Postoperative sagittal MRI showing decompression of the herniated nucleus pulposus. A small remaining sequestrated disk fragment (red arrow) is visible. Imaging after 1 month of follow-up shows regression of the remaining disk fragment on sagittal (B) and axial(C) MRIs.Fig. 18.27 Preoperative sagittal (A) and axial (B) MRIs and axial CT (C) showing a soft central disk herniation at L2-L3.Fig. 18.28 The determination of the skin entry point is shown as described in the text. In this case the entry point (arrows) is ~10 cm from the midline.
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Jul 12, 2020 | Posted by drzezo in NEUROSURGERY | Comments Off on 18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Central Transforaminal L2-L3 Protrusion
5 Anesthesia
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