Endoscopic Transforaminal Discectomy Vs. Far Lateral Discectomy for Extraforaminal Disc Protrusions: Our Experience
Methods: We prospectively collected 38 patients who underwent surgery for lumbar extraforaminal disc prolapse, from January 2014 to December 2018. Twenty patients underwent far lateral microsurgical discectomy, whereas eighteen a percutaneous transforaminal endoscopic discectomy. Patients were randomly assigned to a treatment group and were followed-up at intervals of 3, 6, and 16 months. No patients were lost at follow-up. Data were collected on leg pain and disability degree, preoperatively and at follow-up visits, along with demographic data, operative time, amount of intraoperative blood loss, and any postoperative surgical adverse events. Eventually, data analyzed and compared between the two groups.
Results: Mean operative time was significantly shorter for endoscopically treated patients compared to patients who underwent microdiscectomy (59.4 vs. 98 minutes, p-value < 0.001). Also, intraoperative blood loss was almost negligible (< 50 ml) for all endoscopically treated patients. There were no differences in terms of postoperative outcomes between patients treated with standard microsurgical techniques and patient who underwent endoscopic transforaminal discectomy at 3, 6, and 16 months of follow-up.
Conclusions: transforaminal endoscopic discectomy is a feasible and safe procedure for the treatment of extraforaminal lumbar disc herniation. Our series highlighted the utility and feasibility of the technique, showing similar results to far lateral microsurgical technique.
Al-Khawaja DO, Mahasneh T, Li JC. Surgical treatment of far lateral lumbar disc herniation: a safe and simple approach. Journal of Spine Surgery 2016; 2(1) :21-24.
Choi KC, Shim HK, Hwang JS, Shin SH, Lee DC, Jung HH, Park HA, Park CK. Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World neurosurgery 2018; 116: e750-e758.
Guiroy A, Sícoli A, Masanés NG, Ciancio AM, Gagliardi M, Falavigna A. How to perform the Wiltse posterolateral spinal approach. Surgical neurology international. 2018; 9: 38.
Kong W, Liao W, Ao J, Cao G, Qin J, Cai Y. The strategy and early clinical outcome of percutaneous full-endoscopic interlaminar or extraforaminal approach for treatment of lumbar disc herniation. BioMed research international, 2016.
Lee JS, Kim HS, Jang JS, Jang IT. Structural preservation percutaneous endoscopic lumbar interlaminar discectomy for L5-S1 herniated nucleus pulposus. BioMed research international 2016; p. 6250247.
Matsumoto M, Ishii K, Watanabe K, Tsuji T, Takaishi H, Nakamura M, Toyama Y, Chiba K. Microendoscopic discectomy for lumbar disc herniation in the elderly. Asian Journal of Endoscopic Surgery 2010; 3(4): 174-179.
Papavero L and Kothe R. The translaminar approach for cranially extruded lumbar disc herniations. Operative Orthopädie und Traumatologie 2013; 25(1): 6-15.
Tacconi L and Spinelli R. Far Lateral Disk Prolapsed: a Preliminary Experience by Percutaneous Endoscopic Approach. A Ten Years Experience. Open Access J Neurol Neurosurg 2018; 7(2): 555710.
Tacconi L. Lumbar discectomy: has it got any ill-effects?. Journal of Spine Surgery 2018; 4(3): 677.
Vogelsang JP and Maier H. Clinical results and surgical technique for the treatment of extreme lateral lumbar disc herniations: the minimally invasive microscopically assisted percutaneous approach. Central European Neurosurgery-Zentralblatt für Neurochirurgie 2008; 69(01): 35-39.
Wang B, Lü G, Liu W, Cheng I, Patel AA. Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: the causes and prophylaxis of conversion to open. Archives of orthopaedic and trauma surgery 2012; 132(11): 1531-1538.
Wiltse LL and Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine 1988; 13(6): 696-706.
Yang JS, Zeng YS, Liu TJ, Hao DJ. Full-Endoscopic Procedures Versus Traditional Discectomy Surgery for Discectomy: A Systematic Review and Meta-analysis of Current Global Clinical Trials. Pain physician 2017; 20(7): E1123-E1124.
Yoshimoto M, Iwase T, Takebayashi T, Ida K, Yamashita T. Microendoscopic discectomy for far lateral lumbar disk herniation: less surgical invasiveness and minimum 2-year follow-up results. Clinical Spine Surgery 2014; 27(1): E1-7.
Zheng C, Wu F, Cai L. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children. International orthopaedics. 2016; 40(6): 1099-1102.