AUTHOR=Jiang Yi , Zuo Rujun , Yuan Shuai , Li Jian , Liu Chang , Zhang Jiexun , Ma Ming 

TITLE=A Novel Trajectory for a Transpedicular Approach in the Treatment of a Highly Downward-Migrated Lumbar Herniation with a Full Endoscopic Technique

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.915052

DOI=10.3389/fsurg.2022.915052

ISSN=2296-875X

ABSTRACT=Background: To evaluate the clinical outcome of full endoscopic discectomy using a novel trajectory via transpedicular approach.
Method: Thirty-five patients were enrolled in this retrospective study between July 2014 and October 2019 in Beijing Haidian hospital. All patients were treated with full-endoscopic lumbar discectomy via transpedicular approach with an oblique trajectory. The imaging parameters, including pedicle height and angle of trajectory, were recorded. The preoperative and post-operative clinical data were collected for statistical analysis. 
Results: All patients underwent successful surgery without severe complications. We compared the visual analogue scale and Oswestry disability index scores before and after surgery. The differences were statistically significant (P < 0.05). According to the modified Macnab criteria, the good-to-excellent rate was 85.7% at the last follow-up. The average angle of trajectory in sagittal and coronal planes were 34.5°±2.9° and 47.1°±5.0°, respectively.
Conclusion: The new trajectory of the transpedicular approach with full endoscopic technique for extremely downward-migrated disc herniation showed excellent results in a small sample study. A precise surgical plan is required, comprising measurements of the pedicle height and angle of the bone tunnel.