Percutaneous endoscopic lumbar discectomy (PELD) via a posterolateral approach has become more effective at removing the central herniated nucleus pulposus (HNP), as a result of the introduction of adjustable articulating forceps. However, the forceps’ enlarged diameter prevents the instrument from being inserted inside of the endoscope, thus it requires performing only in the working channel under a lateral fluoroscope. This limitation has increased the risk of spinal cord injury. Therefore, we decided to place a flexible epiduroscope into the targeted anterior epidural space to reduce the risk of injury before performing discography with a mixture of contrast medium and indigo carmine. A blue-stained leakage from the HNP during discography could be observed through the epiduroscope, while the contrast medium leakage was seen on the lateral fluoroscopic view simultaneously. After removing the adequate volume of HNP, the compressed anterior epidural space widened. PELD, under the observation of epiduroscopy, was safe to perform an adequate amount of mechanical decompression of the affected neural structures without the possibility of spinal cord damage.
Kyunghoon Kim, M.D., Ph.D.
Professor, Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University Geumor 20, Mulgeumup, Yangsan 626-770, Korea
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