Purpose: The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach.
Methods: Three patients with high-grade down-migrated L3-4 and L4-5 disc herniation presented to our hospital. Each underwent PELD via a facet process and pedicle complex approach to remove the herniated fragment and achieve complete decompression of the nerve root.
Results: Patients' symptoms were relieved. Postoperative magnetic resonance imaging showed root decompression. Follow-up 12-month computed tomography revealed no pedicle or facet fracture and healing of the pedicle complex and facet process bone tunnel.
Conclusion: PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.
Keywords: Facet process; High-grade down-migration; Lumbar disc herniation; Pedicle complex; Percutaneous endoscopic lumbar discectomy (PELD).