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 similar to 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.