Carbon Dioxide (CO2) Laser-Assisted Microdiscectomy for Extraforaminal Lumbar Disc Herniation at the L5-S1 Level

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The purpose of this study was to analyze the surgical outcomes of carbon dioxide (CO(2)) laser-assisted microdiscectomy for extraforaminal lumbar disc herniations (EFLDH) at the L5-S1 level. Microdiscectomy via the lateral transmuscular route is beneficial for treating EFLDH at the L5-S1 level. However, this technique may not effectively remove concomitant foraminal lumbar disc herniation (FLDH), resulting in persistent leg pain and a necessity for revision surgery. CO(2) laser-assisted microdiscectomy could be an effective alternative, as it enables effective decompression of EFLDH as well as of the accompanying FLDH, despite a narrow operative window. Thirty-one consecutive patients with EFLDH at the L5-S1 level who underwent CO(2) laser-assisted microdiscectomy via the lateral transmuscular route were prospectively enrolled. Clinical outcomes were assessed 1 year after surgery by using the visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), and patient's subjective satisfaction rate. Of the 31 patients, 10 were male and 21 were female, with a mean age at surgery of 62.2 years. All patients showed improvement in leg pain immediately after surgery. Transient dysesthesia developed in one patient. Of the 28 patients (90.3%) followed for a 1-year period, the mean VAS for back pain and leg pain, as well as the mean ODI, decreased significantly from 5.2, 8.3, and 60.7% to 2.6, 1.8, and 18.1%, respectively. The mean subjective satisfaction rate was 75.7%. Clinical success was observed in 27 patients (96.4%), and reherniation occurred in one patient (3.6%). No patient underwent reoperation for reherniation or segmental instability. CO(2) laser-assisted microdiscectomy for EFLDH at the L5-S1 level showed satisfactory surgical results at the 1-year follow-up.