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Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach for Removal of Dorsally Migrated Lumbar Disc Herniation: A case report with technical note
Hyeun Sung Kim1, Byapak Paudel1, Jee Soo Jang1, Seong Hoon Oh2, Il Tae Jang3
1Nanoori Suwon hospital, Suwon-si, Gyeonggi-do, , Korea
2Department of Neurosurgery, Nanoori Hospital(Incheon),, In-cheon city, Korea
3Department of Neurosurgery, Nanoori Hospital, Seoul, Seoul city, Korea
Correspondence :  Byapak Paudel ,Tel: +82-31-1688-9797, Fax: + 82-31-8065-9701, Email: drbyapak@gmail.com
Received: December 8, 2016  Revised: March 13, 2017   Accepted: March 22, 2017
Introduction: Treatment of dorsally migrated lumbar disc described so far commonly in present literature is removal by open technique through hemi or complete laminectomy or by use of microsurgical technique or by partial use of endoscope without use of irrigation system. We present a case of dorsally migrated disc herniation treated safely with good outcome by Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach. Case description: A 60 years old man presented with subacute onset of back pain and right leg radiating pain with weakness of right great toe dorsiflexion and diagnosed as a case of dorsally migrated L4-5 disc herniation was treated with this technique. He had also subtle instability at that level.His pain resolved immediately after surgery. Weakness of right great toe also resolved gradually in 2 months. Postoperative X-ray showed no further instability. Postoperative MRI revealed complete removal of disc with resolution of cauda equina compression. No complication was noted related to this technique.
This new technique ultimately preserves motion segment while simultaneously addressing symptomatic pathology of dorsally migrated HNP with added benefits of minimally invasive spine surgery.
KeyWords: Dorsally migrated lumbar disc herniation; Ligamentum flavum splitting interlaminar approach; Percutaneous full endoscopic removal; Subtle instability
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