Abstract
BackgroundFull-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a high-grade migrated herniated disc. However, because of the complexity of the surgery, success is dependent on the surgeon’s skill. Therefore, patients are frequently treated using open discectomy. Anatomical constraints and technical difficulties can lead to the incomplete removal of high-grade migrated discs.MethodsWe retrospectively reviewed patients who had undergone FELD performed by a single surgeon between January 2010 and January 2014 from a prospective spine registry in an institute. Perioperative records and data of the Oswestry Disability Index, visual analog scale scores (preoperatively and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years after the operation), and MacNab criteria were collected.ResultsOf 58 patients with a follow-up duration of > 5 years, (41 and 17 patients had undergone transforaminal endoscopic lumbar discectomy [TELD] and interlaminar endoscopic lumbar discectomy [IELD], respectively), the satisfaction rate was 87.8% (five unsatisfactory cases) for TELD and 100% for IELD. The overall percentage of patients with good to excellent results according to modified MacNab criteria was 91.3% (53/58 patients). Two patients had residual discs. Two patients needed an open discectomy due to recurrent disc herniation. One IELD patient received spinal fusion surgery due to segmental instability after 5 years.ConclusionFELD has a high success rate for the management of high-grade migrated herniated discs. In patients with high-grade disc migration from L1 to L5, TELD is effective and safe. However, for L4–L5 and L5–S1 high-grade upward and downward disc migration, IELD is the favorable option and provides high patient satisfaction.
Highlights
Full-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a highgrade migrated herniated disc
Because of the high failure rate of FELD in high-grade migrated disc herniation, open surgery is usually suggested; FELD is usually difficult because of anatomical barriers encountered when removing high-grade migrated discs, which can result in the incomplete removal of the disc material [4, 8]
We examined the long-term outcomes of patients with high-grade migrated disc herniation treated using FELD, and we reviewed the literature for the analysis of relevant surgical techniques
Summary
Full-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a highgrade migrated herniated disc. In 1975, Hijikata described the first percutaneous discectomy; since full-endoscopic lumbar discectomy (FELD) has been frequently used for managing lumbar disc herniation [1, 2]. This alternative to conventional open discectomy has many benefits, such as decreased tissue trauma; lower postoperative instability; no interference with the epidural venous system, which, if damaged, may result in fibrosis and chronic neural edema; and faster recovery [3, 4]. Because of the high failure rate of FELD in high-grade migrated disc herniation, open surgery is usually suggested; FELD is usually difficult because of anatomical barriers encountered when removing high-grade migrated discs, which can result in the incomplete removal of the disc material [4, 8]
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