1. Post procedure follow up 2 week:
E -Percutaneous Transforaminal Endoscopic Discectomy in a Patient with L4-5 disc Extrusion: A Case Report
Authors: Dr Nand lal; Dr Devendra Singh; Dr Sujeet Gautam; Dr Anil Agarwal; Dr Sandeep Khuba; Dr Sanjay Kumar
SGPGIMS, LUCKNOW
45 year old male had complains of low back pain with left leg radicular pain along L5, S1 distribution since 4 years.
MRI lumbar spine showed left paracentral disc extrusion at L4-5 with spinal canal stenosis and left neural foraminal narrowing and cranial disc migration
RESULTS
The procedure was accomplished in 90 mins and three large pieces of extruded disc material were removed along with some small pieces of nucleus. Immediately after the procedure patient had significant relief in pain and stretching sensation in the left lower limb; Meckenzie test which was positive earlier became negative. Patient was discharged on the next day and advised to perform light activities
Transforaminal epidural
Needle position
L4-5 PIVD
Disc extrution
Endoscopic view of disc
Extruded disc
L4-5 Percutaneous Transforaminal Endoscopic Discectomy
L4-5 percutaneous transforaminal endoscopic discectomy was accomplished with a posterior-lateral approach that accesses the disc space through the intervertebral foramen under fluoroscopic guidance. After 1% lignocaine infiltration both guide wire, and dilator were used to place a 6.5mm diameter working sleeve into the disc through Kambin’s triangle. Endoscope used to resect disc material under direct visualization
Annuloplasty
Relieved disc material
Epidural fat
Post procedure follow up 2 week:
100% relief in radicular symptoms
except planter extensor weakness
Guidewire in
Lateral view
Patient positioning
Endoscope sheath
Guidewire in AP view