The Internet Journal of Minimally Invasive Spinal Technology 2009 : Supplement II - to IJMIST Vol III No 4
T. Hoogland
ALPHA-KLINIK, Munich
München Germany
M. Schubert
ALPHA-KLINIK, Munich
München Germany
K. Brekel-Dijkstra
ALPHA-KLINIK, Munich
München Germany
B. Miklitz
ALPHA-KLINIK, Munich
München Germany
Citation: T. Hoogland, M. Schubert, K. Brekel-Dijkstra & B. Miklitz : Endoscopic Transforaminal Discectomy For Recurrent Lumbar Disc Herniation. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4
Purpose Recurrent disc herniation is a significant problem as scar formation and progressive disc degeneration may lead to increased morbidity with re-operation. The advantage of the ETD is that there is no need to go through the old scar tissue. The disadvantage may be a long learning curve for the surgeon. Purpose of this prospective study was to review complications and results of the Endoscopic Transforaminal Discectomy (ETD) for recurrent herniated discs. Material and Methods 262 consecutive patients over a four year period with a MRI proven recurrent disc herniation in the lumbar spine with primarily radicular symptoms who did not respond satisfactory to conservative treatment over were included in this prospective clinical study. From a lateral approach first the intervertebral foramen was enlarged and a working cannula was inserted into the spinal canal. The prolapsed or extruded part was removed under endoscopic view with special forceps’s. With a special reamer the inferior endplate was perforated, abraded and all loose intradiscal fragments were removed. Results 3 months post-operative all patients underwent a clinical evaluation and at two years post-operative 90.8% returned an extensive questionnaire including VAS Scores, MacNab Score as well as subjective satisfaction assessment. At two years 85.7% of the patients rated the result of the surgery as excellent or good. 9.7 % reported a fair and 4.6 % patients an unsatisfactory result. Patients recorded an average improvement of their leg pain of 5.9 points and 5.7 points of their back pain on the VAS scale (1-10). According to Mac Nab criteria 30.7% of the patients felt fully regenerated, 50 % felt their efficiency to be slightly restricted, 16.8% felt their efficiency noticeably restricted and 2.5% felt unaltered. All patients had a 3-month follow-up where possible complications were registered. 3 transient nerve root irritations and 6 (2.3%) early recurrent herniations (<3 months) were reported. There was no case of infection or discitis. 11 patients have been re-operated for recurrence, after 3 months and within 2 years (4.6%). Conclusion Endoscopic Transforaminal Discectomy appears to be an effective treatment for recurrent disc herniation with only few complications and a high patient satisfaction.
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