Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

doi:10.4184/asj.2012.6.2.98

Asian Spine J. 2012 June; 6(2): 98–104.

Published online 2012 May 31. doi: 10.4184/asj.2012.6.2.98

PMCID: PMC3372555

Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

Erdinc Civelek,¹ Ilker Solmaz,¹ Tufan Cansever,² Bulent Onal,¹ Serdar Kabatas,² Nail Bolukbasi,³ Sait Şirin,¹ and Serdar Kahraman¹

¹Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey.

²Department of Neurosurgery, Baskent University Istanbul Hospital, Istanbul, Turkey.

³Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey.

Corresponding author.

Corresponding author: Erdinc Civelek, MD. Department of Neurosurgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey. Tel: +90 532 326 2494, Fax: +90 312 304 5316, Email: civsurgeon/at/yahoo.com

Received June 8, 2011; Revised August 11, 2011; Accepted August 25, 2011.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Clinical study.

Purpose

The dimensions of the working zone for endoscopic lumbar discectomy should be evaluated by preoperative magnetic resonance images. The aim of this study was to analyze the angle of the roots, root area, and foraminal area.

Overview of Literature

Few studies have reported on the triangular working zone during transforaminal endoscopic lumbar discectomy. Many risk factors and restrictions for this procedure have been proposed.

Methods

Images of 39 patients were analyzed bilaterally at the levels of L3-L4 and L4-L5. Bilateral axial and coronal angles of the roots, root area, and foraminal area were calculated.

Results

No significant difference was observed between the axial angle of the left and right L3 root. A significant difference was found between the axial angle of right and left L4 roots. A significant difference was observed when the coronal angle of the right and left L3 roots were compared, but no significant difference was found when the coronal angle of the right and left L4 roots were compared. No significant difference was observed when the foraminal area of the right and left L3 and L4 roots were compared, but a significant difference was observed when the root area of right and left L3 and L4 roots were compared.

Conclusions

We suggest that these radiological measurements should be obtained for safety reasons before endoscopic discectomy surgery.

Keywords: Triangular working zone, Endoscopy, Lumbar

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