Analysis of Clinical Results of Three Different Routes of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for Lumbar Herniated Disk Hyeun Sung.

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Analysis of Clinical Results of Three Different Routes of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for Lumbar Herniated Disk Hyeun Sung Kim, Farid Yudoyono, Byapak Paudel, Ki Joon Kim, Jee Soo Jang, Jeong Hoon Choi, Sung Kyun Chung, Jeong Hoon Kim, Il Tae Jang, Seong Hoon Oh, Jae Eun Park, Sol Lee World Neurosurgery Volume 103, Pages 442-448 (July 2017) DOI: 10.1016/j.wneu.2017.04.008 Copyright © 2017 The Author(s) Terms and Conditions

Figure 1 Types of lumbar disk herniation. (A) Foraminal route disk herniation, including far lateral, foraminal, and superior migration disk herniations. (B) Intervertebral route disk herniation, including paracentral, and central disk herniation. (C) Suprapedicular route disk herniation, including inferior migrated disk herniation. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 2 Percutaneous endoscopic transforaminal lumbar discectomy surgical routes. (A, B) Lateral view. (C) Posterior view. In circle: (A) Foraminal route. (B) Intervertebral route. (C) Suprapedicular route. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 3 Illustrative surgical view of percutaneous endoscopic transforaminal lumbar discectomy. (A) Exiting type (blue). (B) Intervertebral type (green). (C) Traversing type (red). World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 4 Manual back muscle assessment methods. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 5 Intraoperative endoscopic view of out-and-in transforaminal approach and the 3 different approach routes. Intraoperative views: (A) initial endoscopic view of the transforaminal space under the out-and-in approach—(a) facet and (b) soft tissues in foramen over disc; (B) the transforaminal space after clearing of the transforaminal space by using radiofrequency—(a) facet, (b) suprapedicular notch area, (c) cranial foraminal area, (d) epidural area, and (e) disc; (C) the foraminal route—(a) traversing root, (b) exiting root, and (c) axillar area; (D) the intervertebral route—(a) transforaminal ligament, (b) dura, (c) epidural space and fat, (d) posterior longitudinal ligament, (e) annulus, and (f) disc; and (E) the suprapedicular route—(a) superior facet, (b) Pedicle, and (c) suprapedicular notch. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 6 Clinical outcomes of percutaneous endoscopic transforaminal lumbar discectomy. (A) Visual analogue scale (VAS) scores. (B) Oswestry Disability Index (ODI) score. (C) MacNab outcome. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 7 A 62-year-old male patient. (A) T2-weighted sagittal magnetic resonance imaging (T2W MRI) scan showing a superior migrated herniated disk. (B) T2W MRI scan showing a superior migrated herniated disk removed well using the foraminal route. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 8 A 45-year-old male patient. (A) T2-weighted sagittal magnetic resonance imaging (T2W MRI) scan showing a high canal-compromised herniated disk. (B) T2W MRI scan showing a high canal-compromised herniated disk removed well using the intervertebral route. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions

Figure 9 A 72-year-old male patient. (A) T2-weighted sagittal magnetic resonance imaging (T2W MRI) scan showing a high inferior migrated herniated disk at the L3–L4 lumbar level. (B) T2W MRI scan showing a high inferior migrated herniated disk removed well using the suprapedicular route. World Neurosurgery 2017 103, 442-448DOI: (10.1016/j.wneu.2017.04.008) Copyright © 2017 The Author(s) Terms and Conditions