Abstract

Introduction:Surgical management of intraforaminal and extraforaminal disc herniations may be more demanding than operation of intraspinal located pathologies, especially at the level L5-S1. The traditional microsurgery shows good result but problems can occur due to soft tissue damaging. The full-endoscopic operation of lumbar disc herniations inside the spinal canal is sufficiently feasible and a potent alternative to the microsurgical procedure. The objective of this prospective study was to compare the outcome of microscopic-assisted (group 1) with the full-endoscopic (group 2) decompression with trans-/extraforaminal approach in intra-/extraforaminal lumbar disc herniations.Material and Methods:40 patients underwent surgery in trans-/extraforaminal full-endoscopic technique and 40 patients with microscopic-assisted technique. Inclusion criteria were: single-level lateral disc herniation (intra-/extraforaminal), no central or lateral stenosis, no pronounced instabilities or deformities, unilateral leg pain, back pain max. 10/100 VAS. The full-endoscopic operation was performed under continuous irrigation with 6.9-mm endoscopes with a 4.1-mm intraendoscopic working canal. The follow-up was 24 months and included 72 patients. Validated measuring instruments were used in addition to general parametersResults:6 patients in group 1 and 2 patients in group 2 presented transient dysaesthesia. The mean operation time in group 1 was 54 minutes and 21 minutes in group 2. The mean blood loss in group 1 was 85 ml, there was no measurable blood loss in group 2. The maximum time in hospital in group 1 was 7 days and 3 days in group 2. The follow-up showed satisfactory subjective results in 89 % with no significant differences between the two groups in the clinical resluts. This also corresponded to the constant results of the measuring instruments. The postoperative pain symptoms and rehabilitation were significantly reduced in group 2. Recurrence was found in 1 patient in group 1 and 2 patients in group 2 during the postoperative follow-up. Conclusion:Within the indication criteria, the full-endoscopic operation of intra- and extraforaminal lumbar disc herniations is a potential alternative to the microscopic-assisted procedure and it is sufficiently feasible. It is a selective procedure with direct visualization. The decompression is found to be sufficient and the rate of complications is low. Traumatization of the access pathway and the vertebral canal is reduced und shows benefits particularly at L5-S1 compared to the microscopic-assisted procedure. The full-endoscopic operation has advantages with respect to economy and minimal invasiveness.