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Received Apr 6, 2017; Accepted Dec 20, 2017
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1. Introduction
Microdiscectomy is known as a gold standard surgical procedure for lumbar disc herniation (LDH) [1–6]. However, percutaneous endoscopic discectomy of the LDH has progressed considerably since introduction of the concept by Kambin in the year 1973 [1, 7–11]. Recently, percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has gained popularity to treat LDH, due to lesser injury inflicted to the posterior spinal muscle, lesser iatrogenic instability, smaller scar in the epidural space, and lesser retraction of the neural tissue. Because of the difficulty in accessing the migrated disc due to the presence of anatomical barriers like pedicle and narrowing of the foraminal space, PETLD has not been considered as an optimal treatment option for a high grade inferiorly migrated disc along the traversing root [9, 11–15]. High grade inferiorly migrated LDH is defined as a disc migration beyond the inferior margin of the pedicle.
Success rate of the surgery in the high grade inferiorly migrated LDH might be low due to remnants of the disc fragment [9, 13, 14]. Advances in surgical equipment present an opportunity to improve the surgical efficacy [5, 15, 16] for high grade inferiorly migrated LDH. We applied a transforaminal suprapedicular circumferential opening technique (SCOT) for a high grade inferiorly migrated LDH. We want to share our technique and results.
2. Materials and Methods
Eighteen consecutive patients treated between November 2015 and October 2016 using the SCOT were reviewed retrospectively. The inclusion criteria were as follows: (a) patients presented with back pain and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation, confirmed by magnetic resonance imaging (MRI) and (b) failure of conservative therapies over 4–6 weeks. The exclusion criteria were definitive segmental instability, foraminal stenosis, and spondylotic spondylolisthesis. X-ray and CT scan were done routinely preoperatively in all patients in addition to MRI to aid in diagnosis and preoperative planning.
2.1. Surgical Technique
Patient was placed in prone position over Wilson frame on a radiolucent operation table. Under fluoroscopic guidance, entry point was marked. The entry point and trajectory...