Usefulness of Percutaneous Endoscopic Lumbar Foraminoplasty for Lumbar Disc Herniation.

Abstract

Endoscopic foraminoplasty facilitates engagement of the working cannula via the intervertebral foramen, allowing cannula access near a herniated disc (HD) for successful application of percutaneous endoscopic lumbar discectomy (PELD). The purpose of this study was to evaluate the efficacy of foraminoplasty for HD and propose applicable situations for foraminoplasty in PELD. A retrospective review of consecutive patients who underwent PELD was performed. Patients were divided into a foraminoplasty group (FG) and nonforaminoplasty group (NFG). Group differences in disc location and radiologic parameters, such as disc height (DH), foraminal width, lamina angle, facet angle, superior articular process thickness, and iliac height, were evaluated. Clinical outcomes were assessed using a visual analog scale for back and leg pain. There were 136 patients (36 FG and 100 NFG) were. The FG had a significantly smaller DH and higher prevalence of high-grade down migration, downward sequestration, and recurrent HD compared with the NFG. For HDs at the L5-S1 level, the FG had a significantly greater iliac crest height and smaller DH and foraminal width compared with the NFG. For central HDs, the FG had a wider lamina angle and smaller DH compared with the NFG. Improvements in back and leg pain were similar in the 2 groups. Percutaneous endoscopic lumbar foraminoplasty may be effective for small DH, migration, sequestration, recurrent HD, HD in L5-S1 with a high iliac crest, and central HD with a wide lamina angle.