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Far lateral lumbar disc herniation amenable to transforaminal percutaneous endoscopic surgery
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Transforaminal percutaneous endoscopic surgery was found to be an effective, minimally invasive method to address far lateral lumbar intervertebral disc herniation, according to study results.
Fifteen patients with far lateral lumbar intervertebral disc herniation underwent transforaminal percutaneous endoscopic partial discectomy between October 2010 and May 2012. Researchers measured pain pre- and postoperatively using VAS pain scores and evaluated postoperative outcomes with the use of MacNab’s criteria. Median postoperative follow up was 6 months.
The researchers also performed a systematic review of the literature, including 14 studies in their evaluation.
Patients’ median operative time was 100 minutes, and median intraoperative blood-loss volume was 20 mL. Of the 15 patients who underwent transforaminal percutaneous endoscopic surgery, only one had a complication, which was numbness of the leg caused by ganglion injury. By final follow-up, this patient had no pain and only a few areas of numbness that did not the leg’s motor function, according to the researchers.
Using MacNab’s criteria, the researchers rated 12 patients’ surgical outcomes as excellent, two as good and one as fair. Patients’ median VAS pain scores were 7.5, 3 and 1.5, respectively. Overall, VAS pain improved significantly from baseline to final follow-up, according to the researchers.
With regard to the systematic review, a total of 1,695 patients with disc herniation were included, with a duration of follow-up ranging from 3 to 38.8 months.
Among the 10 studies that provided duration of follow-up data, nine of them reported excellent or good outcomes for more than 80% of the patients, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopJohn Glaser, MD
The experience of Drs. Liao and Wang gives us further documentation of the role of endoscopic spine surgery. They report generally good results in the treatment of far lateral lumbar disc herniations with an accompanying literature review. Although this clearly is not definitive, it does show that in the right hands, this procedure is an option. I also believe there is value to their more anecdotal suggestions toward the end of the manuscript. My take-home point from these is that this procedure is not without risk and the surgeon needs to be comfortable with this technique when doing this procedure.
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