Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations

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Object. Far-lateral (extraforaminal) and foraminal disc herniations comprise up to 11% of all herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Accessing these lateral disc herniations endoscopically via a percutaneous transforaminal approach offers several theoretical advantages over the more traditional procedures. The object of this study was to assess the safety and efficacy of treating patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach.

Methods. A retrospective analysis was performed of 47 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Outcome was measured with Macnab criteria and by determining a patient's return-to-work status. The median follow-up period was 18 months (range 4–51 months). Excellent or good outcome was obtained in 40 (85%) of 47 patients. Of the 38 patients working before the onset of symptoms, 34 (90%) returned to work. Five patients (11%) experienced poor outcomes and subsequently underwent open procedures at the same level. Of the 10 recipients of Workers' Compensation, Macnab criteria indicated a significantly worse outcome (70% excellent or good), but an excellent return-to-work status was maintained (90%). There were no complications.

Conclusions. Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far-lateral and foraminal disc herniations.

Article Information

Address reprint requests to: Sean M. Lew, M.D., Division of Neurosurgery, University of Vermont, Given Building D-319, Burlington, Vermont 05405. email: Sean.Lew@vtmednet.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Photograph of a model depicting the triangular working zone, which is bounded superiorly and anteriorly by the nerve root, inferiorly by the transverse process, and medially by the superior facet.

  • View in gallery

    Intraoperative photographs demonstrating the endoscopic view. a–c: The cannula (C), annulus (A), nerve root (NR), annulotomy (AN), disc fragment (DF), and pituitary forceps (PF) are visualized.

  • View in gallery

    Photograph showing a disc fragment removed using the endoscopic technique, demonstrating the size of material that can be removed through the cannula (centimeter scale).

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