Prospective evaluation of transabdominal percutaneous lumbar discectomy for L5–S1 disc herniation: initial clinical experience

Abstract

Anterior approaches to the lumbosacral spine have become an increasingly common procedure in spine surgery, but transabdominal percutaneous lumbar discectomy (TPLD) performed anteriorly under fluoroscopic guidance is challenging. In this study the authors describe the TPLD and evaluate its safety and early clinical results in the management of L5-S1 disc herniation. Between January 2005 and June 2007, 30 consecutive patients with L5-S1 disc herniation were treated with L5-S1 TPLD. All procedures were performed with the patient in a state of local anesthesia. After bowel preparation, the hypogastrium was compressed to move the intestinal canal away from the puncture site. The TPLD was then performed with fluoroscopic guidance to remove herniated disc material. Patients were evaluated prospectively using the visual analog scale (VAS) and the Oswestry Disability Index (ODI) during <or= 30 months of follow-up. The mean hospital stay was 6.7 days. Scores on the VAS for leg pain (preoperative mean score 7.10, postoperative mean score 0.93) and the ODI (preoperative mean index 62.03, postoperative mean index 10.33) were statistically significantly (p=0.00) improved at the last follow-up examination compared with preoperative scores. All members of the study group showed favorable results. On the day after the procedure pancreatitis developed in 1 patient but was cured by fasting and intravenous nutrition with antibiotics for 7 days. No other complications occurred during the follow-up. Transabdominal percutaneous lumbar discectomy is a safe, effective, and minimally invasive procedure for the treatment of disc herniations at the L5-S1 level.