A Novel Combination of Percutaneous Endoscopic Lumbar Discectomy and Epiduroscopic Laser Neural Decompression for Down-migrated Disc Herniation

作者：Choi Kyung Chul; Lee Dong Chan; Park Choon Keun

来源：Pain Physician, 2017, 20(4): E605-E609.

DOI：10.36076/ppj.2017.e609

<jats:p>Although percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment
for herniated discs, its application in a disc with extensive migration is still challenging.
As such, epiduroscopic laser neural decompression (ELND) provides a new view of the
epidural space as well as an alternative treatment for a herniated disc and epidural
fibrosis. In this paper the authors introduce the novel combination of PELD and ELND for
high grade down-migrated disc herniation.
An 87-year old woman presented with severe pain radiating down her leg due to high
grade down-migrated disc herniation at L4-5. The therapeutic plan was organized into
3 steps. First, the patient underwent PELD to remove the paracentral extruded disc and
open the epidural space between the traversing nerve root and disc space. Second, ELND
was performed to remove the down-migrated disc and simultaneously push the free
fragment to the L4-5 disc space. Lastly, repetitive free fragments were picked up and
streamed upward using ELND. The patient reported significant reduction of pain after
surgery. Postoperative magnetic resonance imaging (MRI) showed complete removal of
the ruptured disc fragment.
A combination of PELD and ELND may be an option of treatments for down-migrated
disc herniation.
Key words: Percutaneous endoscopic lumbar discectomy, epiduroscopic laser neural
decompression, down-migrated disc herniation</jats:p>

• 出版日期2017-6