Percutaneous endoscopic lumbar discectomy by transfacet join
He accurate and smooth establishment of a working cannula guarantees rapid and minimally invasive treatment effects using percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH). With anatomic variations such as a hyperplastic superior articular process (SAP), the conventional transforaminal approach cannot achieve an ideal result.

Published in the journal Medicine, the authors describe a case of a 48-year-old male patient who suffered waist and left lower limb pain, with exacerbation of symptoms after exertion. He was diagnosed with L5-S1 disc herniation, hyperplastic SAP of S1.

To demonstrate the segment responsible for compression, a lumbar nerve root block was carried out. This was followed by PELD via a transfacet joint approach at L5-S1. The patient experienced an improved quality of life postoperatively (i.e., visual analog score for pain = 1 and Oswestry disability index = 88). Lumbar function and stability were preserved as of the 1-month postoperative follow-up.

Lessons learnt:-
- The transfacet joint approach could extend the indications for PELD and present an alternative option in selected cases.

- A new concept of “subsidence foramen” is raised to characterize this anatomic variation, and it may guide working access establishment of PELD.

-In addition, reading imaging results carefully and individualizing treatments promote the use of PELD as minimally invasive surgery.

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