Biportal endoscopic discectomy for high-grade migrated lumbar disc herniation

Taewook Kang MD, Si Young Park MD, PhD, Gun Woo Park MD, Soon Hyuck Lee MD, PhD, Jong Hoon Park MD, PhD and Seung Woo Suh MD, PhD
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  • Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
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OBJECTIVE

Although endoscopic procedures for lumbar disc herniation have improved greatly and offer many advantages, the indications are limited mostly to nonmigrated or low-grade migrated disc herniation. Endoscopic application in migrated disc herniation cases is still challenging and technically demanding. The goal in this study was to determine the feasibility of biportal endoscopic discectomy for removal of high-grade migrated disc herniation.

METHODS

A retrospective review was performed in 262 patients who had undergone biportal endoscopic discectomy after the diagnosis of lumbar herniated disc. According to preoperative MRI findings, disc herniation was classified into 5 zones based on the direction and distance from the disc space. Patients were divided into 2 groups—a high-grade migration group and a low-grade migration group. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified Macnab criteria, and those outcomes and operation time were compared between the 2 groups.

RESULTS

There were 10 patients with “high-grade up,” 8 with “low-grade up,” 98 with disc-level, 102 with “low-grade down,” and 44 with “high-grade down” herniation, thereby yielding 54 patients in the high-grade group and 208 in the low-grade group. Demographic data for the 2 groups showed no significant difference. There was no significant difference between the 2 groups in ODI, VAS, and modified Macnab criteria. Operation time between the 2 groups was not significantly different (60.74 vs 65.63 minutes, p > 0.05).

CONCLUSIONS

Biportal endoscopic discectomy can be effective for high-grade migrated lumbar disc herniation with no prolonged operation time and satisfactory clinical outcomes.

ABBREVIATIONS BMI = body mass index; ODI = Oswestry Disability Index; VAS = visual analog scale.

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Contributor Notes

Correspondence Si Young Park: Korea University College of Medicine, Anam Hospital, Seoul, Korea. drspine90@kumc.or.kr.

INCLUDE WHEN CITING Published online May 15, 2020; DOI: 10.3171/2020.2.SPINE191452.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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