Extradiscal Epiduroscopic Percutaneous Endoscopic Discectomy for Upper Lumbar Disc Herniation A Technical Note.

STUDY DESIGN: This study was a technical case report. OBJECTIVES: To introduce a new transforaminal percutaneous endoscopic lumbar discectomy (PELD) technique for the treatment of upper lumbar disc herniation using an extradiscal epiduroscopic approach. SUMMARY OF BACKGROUND DATA: Although upper lumbar disc herniation accounts for only 1%-2% of all cases of lumbar disc herniation, the treatment is difficult and shows relatively poor outcomes compared with lower lumbar disc herniation. The anatomic characteristics of the upper lumbar spine are somewhat different from those of the lower lumbar spine. Thus, conventional transforaminal PELD may fail to remove the herniated disc. METHODS: In the setting of extradiscal epiduroscopic PELD for upper lumbar disc herniation, the approach angle on the axial plane is ~30 degrees, which is less than that of the conventional transforaminal endoscopic discectomy and the working cannula is directly targeted to the herniated disc. Four patients who presented with back and/or leg pain due to disc herniation at L1-L2 or L2-L3 disc space were treated with extradiscal epiduroscopic PELD. RESULTS: The patients experienced relief from symptoms and were discharged the next day. CONCLUSIONS: Extradiscal epiduroscopic PELD is a promising treatment strategy for upper lumbar disc herniation, which may otherwise lead to a poor outcome.

Butterfly vertebra with lumbar intervertebral disc herniation.

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus.

Gas-Filled Intradural Cyst within the Cauda Equine.

A case of radicular pain that resulted from a gas-filled intradural cyst in an 80-year-old male is described. Temporary improvement of radicular pain was observed after CT-guided aspiration. However, recurrent radicular pain led to surgical treatment. In this report, the authors document the radiologic and intraoperative features of a gas-filled intradural cyst that migrated into the nerve root, and propose an optimal treatment plan based on a review of the literature.

Thoracic disk herniation manifesting as sciatica-like pain--two case reports.

Two patients presented with sciatica-like pain caused by thoracic disk herniation. Sciatica-like pain was the initial and major symptom in both patients, but careful neurological examination showed vague signs of upper motor neuron disturbance, and thoracic magnetic resonance (MR) imaging revealed disk herniations at the mid-thoracic level. After video-assisted thoracoscopic discectomy, the pain was completely improved. Thorough neurological examination and MR imagery of the thoracic spine, and if needed, even the cervical spine, are required if lumbar image findings do not correlate with the symptoms or physical examination.