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

Shin, Myung-Hoon, MD, PhD*; Bae, Jung-Sik, MD; Cho, Hyung-Lea, MD; Jang, Il-Tae, MD, PhD§

doi: 10.1097/BSD.0000000000000755

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.

*Department of Neurosurgery, Incheon St Mary’s Hospital, College of Medicine, The Catholic University

Department of Neurosurgery, Nanoori Gangseo Hospital

Department of Neurosurgery, Nanoori Jooan Hospital

§Department of Neurosurgery, Nanoori Gangnam Hospital, Incheon, Republic of Korea

The authors declare no conflict of interest.

Reprints: Jung-Sik Bae, MD, Department of Neurosurgery, Nanoori Gangseo Hospital, 187, Garogongwon-ro, Gangseo-gu, Seoul, Republic of Korea 07718 (e-mail:

Received April 29, 2018

Accepted October 24, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.