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Radiographic Risk Factors for Unfavourable Outcomes after
Department of Neurosurgery, Bumin Hospital, Busan, Korea
Backgrounds
• Endoscopic interlaminar approach is still more challenging above L4-5 level
• Endoscopic working sheath inserted in narrow interlaminar space can cause dysesthesia or motor weakness.
• This study investigated the radiographic variables related to the interlaminar working zone.
Radiographic risk factor for unfavorable outcome after PIELD at L4-5. Chung et al.
Choi et al. 2006 Operative Neurosurgery
Materials : PEILD at L4-5 levelRadiographic risk factor for unfavorable outcome after PIELD at L4-5. Chung et al.
• Fully endoscopic interlaminar approach– FHD Rigid scope (OD 6.3mm, WchD 3.7mm, OA 30º, WL 125mm, TL 205mm )– Ligamentum flavum splitted and spared– Except for cases with laminotomy
• Jan.2015 – Jul.2016• 34 patients (M:F = 23:11)• Mean age: 49.6 years (19-74)• Mean follow-up : 14.2 months (12-27)• Type of disc protrusion 6%
9%
26%
15%
44% sup.migration
huge rupture
inf.migration
central
paracentral
Methods : Plain radiographyRadiographic risk factor for unfavorable outcome after PIELD at L4-5. Chung et al.
• ILH : Interlaminar space height on anteroposterior radiography• ILW : Interlaminar space width on anteroposterior radiography• ISDf : Interspinous distance of flexion lateral radiography • ISDe : Interspinous distance of extension lateral radiography• ISDd : distance difference between dynamic radiography
ISDf
ISDe
ISDd = IDSf - ISDe
FLEXION EXTENSION
ILH
ILW
AP
Methods : Computed tomographyRadiographic risk factor for unfavorable outcome after PIELD at L4-5. Chung et al.
• SLA : Sublaminar angle of L4 level on sagittal CT image• ILDs : Interlaminar distance at ipsilateral lateral margin of dura on sagittal CT • ILDc : Interlaminar distance at ipsilateral lateral margin of dura on coronal CT
ILDc
ILDs
SLA
midlineparamedian
Results: OverallRadiographic risk factor for unfavorable outcome after PIELD at L4-5. Chung et al.
• Pain score (VAS)
Ave VAS leg 7.7(6-10) → 2.2(1-5) Ave VAS back 3.9(0-8) → 2.1(0-5)
• Group I : Favorable outcome group• Group II : Unfavorable outcome group