Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report
Background: Protrusion, extrusion and sequestrated discs are common types of disc herniation. Protrusion is the variant with intact annulus. Sometimes nucleus pulposus may break through inner layers of the annulus and extrude to lie between the outer and inner layers of the annulus fibers. Such hern...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751921000232 |
| _version_ | 1818676908249841664 |
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| author | Hyeun Sung Kim Ifthekar Syed Ravindra Singh Il Tae Jang |
| author_facet | Hyeun Sung Kim Ifthekar Syed Ravindra Singh Il Tae Jang |
| author_sort | Hyeun Sung Kim |
| collection | DOAJ |
| description | Background: Protrusion, extrusion and sequestrated discs are common types of disc herniation. Protrusion is the variant with intact annulus. Sometimes nucleus pulposus may break through inner layers of the annulus and extrude to lie between the outer and inner layers of the annulus fibers. Such herniation may be called as subannular herniation.The endoscopic approaches are an attractive option in younger population as they are minimally invasive, highly efficient and offer early rehabilitation, early functional recovery and improved quality of life.We report one such case where a challenging herniated subannular nucleus pulposus was treated by outside-in inter-annular Transforaminal endoscopic disc surgery (TELD). Case report: A 17-year-old female presented to our clinic with insidious onset, progressive low back ache and right leg pain of 3 months duration. The pain increased in intensity as the time elapsed and the Visual Analogue Score (VAS) on presentation was VAS- 5 (Back) and VAS-7 (right Leg). These symptoms were also associated with reduced sensations over the right L5 dermatomal distribution and perianal hypo-aesthesia. There was weakness in bilateral great toe dorsiflexion and mild urinary symptoms. Magnetic resonance imaging (MRI) of the Lumbar spine showed a herniated subannular Disc at L4-L5 level with a large central component compressing the thecal sac and traversing nerve root. The patient underwent Mobile Outside-in Interannular Transforaminal Endoscopic Lumbar Discectomy (TELD). Patient’s symptoms improved significantly after surgery and visual analogue score improved to, VAS Back – 1 and VAS Leg – 0. At six months follow up, the neurology was normal. Conclusion: Mobile outside-in, Interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) is an effective, minimally-invasive option to treat sub annular herniated nucleus pulposus. |
| first_indexed | 2024-12-17T08:50:57Z |
| format | Article |
| id | doaj.art-caed093bbcc74b38a5e3ad227e883602 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-17T08:50:57Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-caed093bbcc74b38a5e3ad227e8836022022-12-21T21:56:05ZengElsevierInterdisciplinary Neurosurgery2214-75192021-06-0124101111Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case reportHyeun Sung Kim0Ifthekar Syed1Ravindra Singh2Il Tae Jang3Nanoori Hospital, Gangnam, Seoul, Republic of Korea; Corresponding author.All India Institute of Medical Sciences, Rishikesh, IndiaAlberta Children’s Hospital, University of Calgary, CanadaNanoori Hospital, Gangnam, Seoul, Republic of KoreaBackground: Protrusion, extrusion and sequestrated discs are common types of disc herniation. Protrusion is the variant with intact annulus. Sometimes nucleus pulposus may break through inner layers of the annulus and extrude to lie between the outer and inner layers of the annulus fibers. Such herniation may be called as subannular herniation.The endoscopic approaches are an attractive option in younger population as they are minimally invasive, highly efficient and offer early rehabilitation, early functional recovery and improved quality of life.We report one such case where a challenging herniated subannular nucleus pulposus was treated by outside-in inter-annular Transforaminal endoscopic disc surgery (TELD). Case report: A 17-year-old female presented to our clinic with insidious onset, progressive low back ache and right leg pain of 3 months duration. The pain increased in intensity as the time elapsed and the Visual Analogue Score (VAS) on presentation was VAS- 5 (Back) and VAS-7 (right Leg). These symptoms were also associated with reduced sensations over the right L5 dermatomal distribution and perianal hypo-aesthesia. There was weakness in bilateral great toe dorsiflexion and mild urinary symptoms. Magnetic resonance imaging (MRI) of the Lumbar spine showed a herniated subannular Disc at L4-L5 level with a large central component compressing the thecal sac and traversing nerve root. The patient underwent Mobile Outside-in Interannular Transforaminal Endoscopic Lumbar Discectomy (TELD). Patient’s symptoms improved significantly after surgery and visual analogue score improved to, VAS Back – 1 and VAS Leg – 0. At six months follow up, the neurology was normal. Conclusion: Mobile outside-in, Interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) is an effective, minimally-invasive option to treat sub annular herniated nucleus pulposus.http://www.sciencedirect.com/science/article/pii/S2214751921000232Subannular herniated nucleus pulposusCauda equina syndromeTransforaminal Endoscopic Lumbar Discectomy (TELD) |
| spellingShingle | Hyeun Sung Kim Ifthekar Syed Ravindra Singh Il Tae Jang Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report Interdisciplinary Neurosurgery Subannular herniated nucleus pulposus Cauda equina syndrome Transforaminal Endoscopic Lumbar Discectomy (TELD) |
| title | Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report |
| title_full | Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report |
| title_fullStr | Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report |
| title_full_unstemmed | Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report |
| title_short | Subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside-in, interannular Transforaminal Endoscopic Lumbar Discectomy (TELD) – A case report |
| title_sort | subannular herniated nucleus pulposus with cauda equina syndrome treated by mobile outside in interannular transforaminal endoscopic lumbar discectomy teld a case report |
| topic | Subannular herniated nucleus pulposus Cauda equina syndrome Transforaminal Endoscopic Lumbar Discectomy (TELD) |
| url | http://www.sciencedirect.com/science/article/pii/S2214751921000232 |
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