Percutaneous endoscopic lumbar discectomy and annuloplasty for lumbar disc herniation at the low two contiguous levels: Single-portal, double surgeries

Study Design Technical case report. Objective The authors report surgical experience of treating contained or noncontained lumbar disc herniation (LDH) at the L3-L4 and L4-L5 or L4-L5 and L5-S1 levels by transforaminal percutaneous endoscopic lumbar discectomy and annuloplasty (PELDA) through the single entry point. Summary of Background Data When there are concurrent LDHs involving lower two levels simultaneously, PELDA has not been performed. Methods Between March 2008 and May 2011, eight patients presented with back pain or radicular lower limb pain. Upon radiologic examination using magnetic resonance imaging, the patients were diagnosed with central or paramedian LDH at low spine levels (L3-L4 and L4-L5 or L4-L5 and L5-S1) consistent with their clinical presentations. We performed double PELDA at the affected two levels simultaneously through a single skin portal. Results The symptoms were relieved dramatically, and all patients were discharged the next day. There was no radiologic instability during the follow-up period. Conclusions Transforaminal PELDA to treat two levels of LDH through a single portal could be considered as one of the minimally invasive treatment modalities that avoids conventional open surgery.