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Combined Endoscopic Discectomy and Annulus Fibrosus Repair for Lumbar Disc Herniation: A Case Report
Date：2022-12-02 Read：
Combined Endoscopic Discectomy and Annulus Fibrosus Repair for Lumbar Disc Herniation: A Case Report
Recently, the Department of Orthopedics of the Second Affiliated Hospital of Dalian Medical University successfully performed a combined spinal endoscopic discectomy and annulus fibrosus suture repair under the guidance of Professor Shengwei He, achieving a dual-technique approach in a single endoscopic procedure for the treatment of lumbar disc herniation.
Case Presentation
A 65-year-old male patient presented with low back pain accompanied by radiating pain and numbness in the right lower limb for two months, which had worsened over the preceding two weeks. Physical examination revealed signs consistent with right L5 nerve root compression. Radiographic assessment, including X-ray, CT, and MRI, confirmed the diagnosis of lumbar disc herniation at L4–L5 (right-sided).
X-ray result
CT result
MRI result
Surgical Planning and Procedure
After multidisciplinary preoperative discussion, the surgical team determined that the patient had a contained disc herniation at L4–L5 with foraminal stenosis due to osseous hypertrophy. A minimally invasive spinal endoscopic procedure was planned, consisting of foraminoplasty, nerve root decompression, and discectomy, followed by endoscopic annulus fibrosus repair.
The operation was performed as scheduled, lasting approximately two hours without complications. Postoperatively, the patient experienced immediate and significant relief of low back and radicular pain. He was able to ambulate on the first postoperative day, with complete resolution of symptoms, and was discharged in good condition on postoperative day two.
Surgery in progress
Discussion
The integration of conventional endoscopic discectomy with annulus fibrosus suture repair represents a more comprehensive and definitive approach to lumbar disc herniation. This dual technique not only decompresses the affected nerve root and alleviates pain but also directly repairs the disrupted annulus fibrosus, thereby reducing the risk of recurrence. Successful implementation of this procedure signifies a new milestone for the Diamond Bay Orthopedic Department in the field of spinal reconstruction and minimally invasive endoscopic spine surgery.
Currently, annulus fibrosus repair techniques are becoming increasingly standardized and widely adopted by spine surgeons worldwide. As a direct and effective method for repairing annular defects, this approach addresses the underlying pathology of disc herniation. Its key advantages include:
1. Immediate annular closure under direct visualization, significantly lowering the recurrence risk by preventing re-herniation of nucleus pulposus through the annular defect.
2. Reduction of postoperative inflammatory mediator release and scar adhesion, thereby minimizing residual pain symptoms and facilitating faster recovery.
3. Restoration of normal disc anatomy and preservation of nucleus pulposus tissue, minimizing disruption of the intradiscal microenvironment and promoting disc function recovery, in line with the principles of minimally invasive spine surgery.
Conclusion
This case demonstrates that combined spinal endoscopic discectomy with annulus fibrosus repair is a safe and effective treatment strategy for lumbar disc herniation. The technique provides both symptomatic relief and structural restoration, offering promising potential for reducing recurrence and improving long-term outcomes.
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