Abstract

Purpose: We present our experience with transforaminal endoscopic discectomy and thermal annuloplasty for the treatment of discogenic back pain. Materials and Method: 25 patients with single level of discogenic back pain were treated with transforaminal endoscopic discectomy and thermal annuloplasty like a first choice operation treatment. Patients were previously treated with physical therapy at least six month with no improvement. Discography was performed with all patients same as intraoperative discography with Indigo Carmine dye mixed with Omni Pack 1:5. All patients were operated by senior surgeon using transforaminal endoscopic approach at more painful side. The goal of operation was to identify and remove inflammatory disc and granulation tissue described by A. Yeung. The goal was achieved with 20 patients and at five patients we found foraminal disc herniation. Thermal annuloplasty was performed at all patients using bipolar flexible radiofrequency probe. Patients were examined three and six month after operation. Oswestry questionnaire and VAS scale tests were filled at control examination by all patients. Results: Out of 25 patients, 18 patients responded favorably to the Oswestry questionnaire, indicating significant improvement of their back pain greater than 60% on a visual analog scale. There was one superficial wound infection. Discussion and Conclusion: Treatment for non-radicular back pain is difficult despite all our knowledge and technology. Final solution is commonly fusion surgery but what to do with patients where fusion doesnt work? As a reasonable option we proposed selective endoscopic transforaminal surgery to our selected patients like a first choice minimal invasive treatment before fusion surgery. Out preliminary results and work of other authors convinced us that transforaminal endoscopic decompression combined with annuloplasty could be a first surgical step in process of treating discogenic low back pain.