Full-endoscopic discectomy utilizing an interlaminar approach for gas-containing herniation at L5–S1
- Department of Spinal Neurosurgery, Kyoto Katsura Hospital, Kyoto, Japan
- Department of Neurosurgery, Iwai Full-Endoscopic Spine Surgery (FESS) Clinic, Tokyo, Japan
Correspondence Address:
Yoshihiko Ioroi, Department of Spinal Neurosurgery, Kyoto Katsura Hospital, Kyoto, Japan.
DOI:10.25259/SNI_508_2024
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Yoshihiko Ioroi1, Toshinari Kawasaki1, Jun Hashimoto1, Tamaki Kobayashi1, Hisashi Koga2, Motohiro Takayama1. Full-endoscopic discectomy utilizing an interlaminar approach for gas-containing herniation at L5–S1. 26-Jul-2024;15:265
How to cite this URL: Yoshihiko Ioroi1, Toshinari Kawasaki1, Jun Hashimoto1, Tamaki Kobayashi1, Hisashi Koga2, Motohiro Takayama1. Full-endoscopic discectomy utilizing an interlaminar approach for gas-containing herniation at L5–S1. 26-Jul-2024;15:265. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13005
Abstract
Background: Intradiscal gas is frequently observed in older patients with disc degeneration and can occasionally result in nerve root compression.
Case Description: A 79-year-old male patient presented with increasing left lower extremity sciatica. Lumbar computed tomography (CT) and magnetic resonance (MR) images revealed a left paramedian L5–S1 gas-containing disc herniation. Utilizing an interlaminar approach, a full-endoscopic discectomy (FED) was performed at L5–S1. During disc removal, we countered intradiscal gas bubbles. Postoperatively, the patient’s symptoms/signs fully resolved, and follow-up MR and CT images revealed total resection of the disc herniation, and no further gas.
Conclusion: Through an interlaminar FED, we effectively removed an L5–S1 MR/CT-documented gas-containing disc herniation.
Keywords: Discectomy, Full-endoscopic spine surgery, Gas-containing disc herniation, Interlaminar approach
INTRODUCTION
An intervertebral gas-containing disc herniation (i.e., vacuum phenomenon [VP]) is a relatively common radiographic finding observed in older individuals with disc degeneration, and the gas may further contribute to nerve root compression. Here, we performed an interlaminar full-endoscopic discectomy (FED) to resect a magnetic resonance (MR)/computed tomography (CT)-documented gas-containing L5–S1 disc herniation.
CASE DESCRIPTION
A 79-year-old male patient presented with left lower back pain/lower extremity sciatic that has been persistent for 6 months, without a focal neurological deficit. MR imaging revealed left S1 nerve root compression due to a left paramedian disc herniation at L5–S1 [
Figure 1:
Preoperative magnetic resonance and computed tomography (CT) images. (a, b) Sagittal view and axial view T2-weighted images show disc herniation at L5-S1. Figure 1a is at the level of the yellow line in figure 1b. Figure 1b is at the level of the red line in figure 1a. (c, d) CT of the sagittal and axial views reveal a low-density lesion, which indicates gas within the herniated disc. Figure 1c is at the level of the yellow line in figure 1d. Figure 1d is at the level of the red line in figure 1c.
Video 1
Postoperatively, the patient’s symptoms immediately resolved, and the postoperative MR and CT images revealed no residual disc herniation or gas [
Figure 3:
Postoperative magnetic resonance and computed tomography (CT) images. (a, b) Sagittal view and axial view T2-weighted images show a decrease in disc herniation at L5-S1. Figure 1a is at the level of the yellow line in figure 1b. Figure 1b is at the level of the red line in figure 1a. (c, d) CT of the sagittal and axial views revealed no low-density lesion within the herniated disc. Figure 1c is at the level of the yellow line in figure 1d. Figure 1d is at the level of the red line in figure 1c.
DISCUSSION
“VP” or “intradiscal gas” (i.e., the radiolucent visualization of gas within the intervertebral disc space) is observed in 1–3% of lumbar spinal radiographs and most frequently in older adults (20%).[
No significant differences have been reported regarding clinical efficacy between percutaneous endoscopic lumbar discectomy and posterior open lumbar microdiscectomy.[
CONCLUSION
FED for gas-containing disc herniation may be effective and minimally invasive because of its ability to visualize nerve root decompression.
Ethical approval
The research/study was approved by the Institutional Review Board at Otsu City Hospital, number 100, dated June 13, 2022.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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Disclaimer
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