Choi Kyung-Chul, Lee Dong Chan, Park Choon-Keun
Department of Neurosurgery, Leon Wiltse Memorial Hospital, Anyang.
Department of Neurosurgery, the Leon Wiltse Memorial Hospital, Anyang, Korea.
Pain Physician. 2017 May;20(4):E605-E609.
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.
尽管经皮内镜下腰椎间盘切除术（PELD）是治疗椎间盘突出症的有效方法，但其在广泛移位椎间盘的应用中仍具有挑战性。因此，硬膜外腔镜激光神经减压术（ELND）为硬膜外腔提供了新的视野，也是治疗椎间盘突出症和硬膜外纤维化的一种替代方法。在本文中，作者介绍了PELD和ELND联合应用于高度向下移位的椎间盘突出症的新方法。一名87岁女性因L4-5节段高度向下移位的椎间盘突出症出现严重的腿部放射性疼痛。治疗方案分为3个步骤。首先，患者接受PELD以切除中央旁突出的椎间盘并打开横过神经根与椎间盘间隙之间的硬膜外腔。其次，进行ELND以切除向下移位的椎间盘并同时将游离碎片推至L4-5椎间盘间隙。最后，使用ELND捡起重复的游离碎片并向上推送。患者术后报告疼痛明显减轻。术后磁共振成像（MRI）显示破裂的椎间盘碎片已完全清除。PELD和ELND联合应用可能是治疗向下移位椎间盘突出症的一种选择。
