Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 168-174
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.168
Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report
Xin-Bo Wu, Zi-Hua Li, Yun-Feng Yang, Xin Gu
Xin-Bo Wu, Zi-Hua Li, Yun-Feng Yang, Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
Xin Gu, Department of Orthopedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Author contributions: Wu XB reviewed the literature and drafted the manuscript; Li ZH analyzed the data; Yang YF designed the report; Gu X collected the patient’s clinical data.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin Gu, MD, PhD, Department of Orthopedics, Shanghai Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai 200003, China. guxin2004ty@163.com
Received: October 19, 2019
Peer-review started: October 19, 2019
First decision: November 29, 2019
Revised: December 4, 2019
Accepted: December 6, 2019
Article in press: December 6, 2019
Published online: January 6, 2020
Processing time: 79 Days and 22.6 Hours
Abstract
BACKGROUND

The technique of percutaneous endoscopic lumbar discectomy (PELD) as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations. However, due to the different anatomic characteristics of the upper lumbar spine, conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus. Therefore, the purpose of this study was to describe a novel surgical technique, two-level PELD, for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.

CASE SUMMARY

A 60-year-old male presented with a complaint of pain at his lower back and right lower limb. The patient received 3 mo of conservative treatments but the symptoms were not alleviated. Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg, and preoperative visual analog scale (VAS) score for the lower back was 6 points and for the right leg was 8 points. Magnetic resonance imaging (MRI) demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body. According to physical examination and imaging findings, surgery was the primary consideration. Therefore, the patient underwent surgical treatment with two-level PELD. The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively. The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.

CONCLUSION

Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.

Keywords: Upper lumbar disc herniations; Two-level percutaneous endoscopic lumbar discectomy; Highly migrated disc herniations; Case report

Core tip: Conventional open surgery has been considered a gold standard procedure for highly migrated upper lumbar disc herniations. However, conventional open surgery needs to remove extensive lamina and facet joint, which may induce iatrogenic instability. In this study, we creatively introduced the two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniations, enabling us to completely remove the highly migrated nucleus pulposus and reduce the incidence of surgical complications. Therefore, two-level percutaneous endoscopic lumbar discectomy is a safe and effective procedure for highly migrated upper lumbar disc herniations.