Transforaminal endoscopic surgery in lumbar spine: Technical aspects, current status, and evolving scope

Abstract

Study Design: This study is comprehensive literature review. Aims and Objectives: This study aimed to evaluate the effectiveness of transforaminal endoscopic technique for managing symptomatic lumbar disc herniations and foraminal/extraforaminal/lateral recess stenosis and to assess the comparative status vis-a-vis existing treatment methods. Materials and Methods: A comprehensive systematic literature search of PubMed, Embase, and Cochrane library databases was performed for articles, including case series, randomized controlled trials (RCTs), controlled clinical trials (CCTs), reviews, and metanalysis with the following search terms: transforaminal endoscopic disc surgery, full endoscopic transforaminal surgery, selective endoscopic discectomy, percutaneous endoscopic lumbar discectomy, transforaminal endoscopic surgery for lumbar stenosis, and endoscopic surgery for foraminal stenosis in various combinations. Results: Results were analyzed in terms of efficacy, safety, complications, recurrence rate, and learning curve in comparison with standard preexisting open procedures. Overall, the reviewed literature pointed toward the following observations: the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, faster postoperative rehabilitation, shorter hospital stay, faster return to work than the microsurgical techniques, although some of the observations were limited in their scope. Endoscopic foraminal stenosis decompression could help avoid facetectomy and fusion procedures. Conclusion: Full endoscopic transforaminal surgeries for lumbar disc herniations and foraminal stenosis are safe and effective alternative to open surgery. Similar clinical outcomes as compared with conventional open surgeries can be reached with lesser incidence of complications and better opportunities for revision surgeries, if and when needed.