Interlaminar full-endoscopic discectomy for L5-S1 disc herniations: Surgical technique and early outcomes during the learning curve

Abstract

Background: Interlaminar full endoscopic discectomy has been the least invasive and preferred route to treat disc herniations at L5-S1 and are being increasingly accepted and adopted in many centres. Compared to transforaminal approach, it offers the advantage of a familiar posterior approach with presumably easier transition for surgeons who have been doing another form of minimally invasive spine surgery.Objective: The article describes the surgical steps and early outcomes along the initial learning curve of Interlaminar Endoscopic discectomy for herniated disc at L5-S1 level.Material and Methods: This retrospective study included the first 20 patients who underwent Interlaminar Endoscopic Lumbar Discectomy (IELD) at our center. Patients with unilateral symptoms, failed conservative treatment, and good interlaminar window were selected for IELD. Visual Analog Scale (VAS) score s and McNab criteria were used to assess the outcome. Postoperative magnetic resonance imaging (MRI) was done in the majority of patients to assess and correlate the adequacy of root decompression and extent of discectomy.Results: The mean age of the 20 patients was 41 years (17 to 60 yr) with a male: female ratio of 3:2. The median surgical time was 80 min (40 to 150 min). The mean VAS scores for leg pain reduced from 8.2 preoperatively to 2.1 in the postoperative period. All patients had a minimum follow-up for 6 months. Postoperative MRI was done in 14 patients, which showed complete fragment removal with the good decompression of the nerve root in 12 patients. There was no early recurrence of radicular symptoms in any patient. According to Modified McNab criteria, 8 patients had excellent outcome, 9 patients had good outcome, and 3 patients did fairly well.Conclusion: IELD offers an excellent alternative to tubular surgeries for treating disc pathologies at L5-S1. This series represents the early reports from the first 20 cases at the author's center who have been performing tubular surgeries for more than a decade. With the learning curve been overcome, the technique could be used in a wider array of lumbar spine pathologies henceforth.