Transpedicular endoscopic removal of highly migrated disc herniations of lumbar spine

Background . Highly migrated disc herniations are usually localized in the area of pars interarticularis medially to the vertebral pedicle. Removal of disk herniations of this localization is a difficult technical task. The study objective is to demonstrate the effectiveness of the transpedicular endoscopic discectomy in the treatment of patients with highly migrated disc herniations. Materials and methods . The results of treatment of 12 patients with Macnab zone herniations who were in hospital from 2016 to 2018 were analyzed. All patients underwent transpedicular endoscopic sequestrectomy. Results . Leg pain after surgery regressed in all patients from the initial 7.41 points (visual-analog scale) to 0.67 points by the end of the 1st day, and it was 0.35 points a year later. The average level of back pain by VAS before surgery was 5.25, on the 1st day after surgery – 1.25 points, 1 year after – 0.67 points. Neurological disorders completely regressed in 10 (91.6 %) patients, there were a slight residual L4 dermatome hypesthesia in 2 patients, without disrupting their quality of life. The average Oswestry Disability Index before surgery was 69.17, and 1 year after surgery was 14.12. There were no complications and reoperations. Conclusion . Transpedicular endoscopic discectomy allowed us to achieve good treatment results in patients with migration of a lumbar hernia by the pedicle. It can be a safe and effective alternative to the transforaminal or interlaminar endoscopic technique.