The Usefulness of Percutaneous Endoscopic Technique in Multifocal Lumbar Pathology

Figure 1

Highly inferior migrated disc combined with spinal canal and lateral recess stenosis. (a) Preoperative sagittal and axial T2-weight MRI showing ruptured right side inferior migrated disc material combined with central canal and lateral recess stenosis at L4-5. Red arrow: inferior migrated disc; red circle: stenotic region in spinal canal and lateral recess. (b) Postoperative axial and sagittal T2-weight MRI and CT showing the removed inferior migrated disc materials and decompression of lateral recess at L4-5. Red arrow: decompressed area by removal of inferior migrated disc materials; red circle: decompressed area from preoperative stenosis; blue dotted line: resected plane of superior articular process. (c) Part of inferior migrated disc materials was seen by retraction of flexible probe. Dotted blue line: resected ventral plane of superior articular process by reamers; asterisk: tip of inferior migrated disc materials. (d) Further decompression of lateral recess was performed by drilling. (e) Intraoperative C-Arm image showing the location of drill tip during lateral recess decompression. (f) Totally decompressed traversing root was seen at the end stage of operation blue dotted line: dorsal margin of the traversing root.

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