Abstract

Background Microscopic dorsal lumbar discectomy is the gold standard treatment for lumbar symptomatic disc herniation. To reduce the complication rate and to eliminate the risks of general anaesthesia, more minimal invasive procedures gain significant interest in patients and spine surgeons. Purpose Of this study is to evaluate the effectiveness and complication rate of the endoscopic transforaminal discectomy (ETD) in all kinds of disc herniation whether far above or below the disc level. Study Design A prospective clinical study. Patient Sample 252 consecutive patients over a four year period with a MRI proven disc-herniation in the lumbar spine with radicular symptoms, positive Lasegue (<45), or neurological symptoms that did not respond satisfactory to conservative treatment off al least two months. Outcome Measures The patients had a clinical evaluation 3 months after surgery and returned at two years an extensive questionnaire including VAS Scores, MacNab Score as well as subjective satisfaction Methods: All patients were treated under local anaesthesia and could be discharged the day after surgery. From a lateral approach first the intervertebrale foramen was enlarged and a working cannula was inserted in the spinal canal. The prolapsed or extruded part was removed under endosopic vision with special forcepses, curettes and with an awl and a special reamer the inferior endplate was perforated, abraded and all loose intradiscal fragments were removed. Results: At the two year follow-up 96,4% of the patients reported an excellent or good result, 2,8% a fair and 0,8% unsatisfactory result. Patients reported a significant improvement in leg and back pain according to the VAS scale. According to MacNab criteria: 44,8% of the patients felt fully regenerated, 48,8 % felt their capacity slightly restricted, 5,6% felt they were noticeably restricted and 0,8 % felt unchanged. In 6 (2,4%)cases an early recurrent disc herniation (<3month) appeared. 3 patients (1,2%) had a temporary paraesthesia and foot weakness (which disappeared after 3 months). There were no cases of discitis. 13 patients (5,2%) were treated for recurrent disc herniation (between 3month and 2 years). 10 of those patients where treated endoscopically again, 3 had a microdiscectomy. 10 patients were very satisfied or satisfied after second surgery, one was unchanged and two were unsatisfied. Conclusion: The endoscopic transforaminal discectomy appears to be a safe, effective procedure without significant complications and is an alternative to open microdiscectomy.