Transforaminal Endoscopic Lumbar Discectomy with Foraminoplasty for Down-migrated Disc Herniation: A Single-center Observational Study

Abstract

Objective: Full-endoscopic lumbar discectomy has evolved to be an alternative for the treatment of lumbar disc herniation. Regarding the techniques, the transforaminal approach remains the primary access. The indications of transforaminal endoscopic lumbar discectomy (TELD) have expanded following the evolution of the techniques, especially TELD with foraminoplasty. This study is to evaluate the efficacy of the TELD with foraminoplasty for downward migrated lumbar disc herniation.Methods: The authors conducted a retrospective study with prospectively collected data in a single center. The study enrolled patients with downward migrated lumbar disc herniation undergoing TELD with foraminoplasty from May 2009 to June 2018. All procedures were performed under local anesthesia. Patients' demographics, clinical outcomes, and satisfaction with surgery were recorded. Results: There were 126 patients included in the current study. The mean age was 50.7±17.4 years old. The leg pain and functional outcome scores significantly improved after the operation. There was no neurological deficit or iatrogenic instability requiring fusion surgery. The operation time was within 2 hours in most cases (92%). Thirteen patients reported minor complications, but symptoms were self-limited or responded to conservative treatment. The operation satisfied 94.4% of patients. Seven cases underwent revision surgery within six months due to recurrence.Conclusion: TELD with foraminoplasty under local anesthesia can be an alternative for downward migrated lumbar disc herniation. Nerve root irritation can be detected without intraoperative neurophysiological monitoring when the patient is awake during the procedures. The clinical outcomes were favorable and the risk of complication was low with the current technique.