Transforaminal Percutaneous Endoscopic Lumbar Discectomy (TPELD) in Caudal Migrated Lumbar Disc Herniations: A Case Series and Literature Review

Background data: Since the initial idea by Kambin and Gellman in 1973 of percutaneous posterolateral lumbar disc decompression, the evolution of minimally invasive interventions in disc herniation has been widely growing. The advancements in optics and surgical instruments allowed surgeons to perform true minimally invasive procedures in a wide range of spine pathologies. In addition, transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has been widely used in various degenerative spine pathologies, owing to the presence of high-speed drills, fl exible forceps, scissors, curettes, and probes to manage pathologies such as disc herniation or canal stenosis. Study design: A prospective clinical case study was performed. Purpose: The primary objective of this study was to assess the feasibility of migrated lumbar disc excision by TPELD, and the secondary objective was to report any technical dif fi culty or complications related to the technique. Patients and methods: Between January 2018 and January 2020, 20 patients who underwent TPELD for radiologically veri fi ed caudally migrated lumbar disc prolapse after the failure of conservative therapy were reported. Preoperative and postoperative clinical evaluations were performed for back pain and leg pain by the visual analog scale (VAS) score and for patients ’ disability by Oswestry Disability Index (ODI). The radiological evaluations preoperatively and post-operatively were done by lumbosacral MRI complemented by lumbosacral radiography anteroposterior and lateral views. The follow-up visits for the evaluation were immediately after surgery and 6 months and 1 year postoperatively. Results: A total of 20 cases were involved in this series from January 2018 to January 2020. Nine females and 11 males were included in the study. Postoperatively, the clinical assessment showed improvement in the VAS score of the back pain and leg pain as the mean VAS scores for back pain and leg pain immediately were 4.55 ± 1.70 and 2.4 ± 0.68, respectively. At the 6-month follow-up, the mean VAS scores for back pain, leg pain, and ODI were 2.15 ± 1.03, 1.35 ± 0.74, and 22.2 ± 6.59, respectively. Finally, after 12 months, the mean VAS scores for back pain, leg pain, and ODI were 1.25 ± 0.71, 0.8 ± 0.52, and 15.85 ± 9.22, respectively. Conclusion: Minimally invasive TPELD proves to be a valuable utility in managing migrated disc fragments in lumbar disc Prolapse (LDP). However, it is a technically demanding procedure, but with appropriate tools and introducing angles, it ef fi ciently removes migrated fragments with the preservation of anatomy. Consequently, the stability of the spine is not harmed (2021ESJ248).