Abstract
This study was carried out from 1986 to 1996 to evaluate the technique of translaminal epidural endoscopic discectomy in lumbar hernias occupying over 50% of the radicular canal, foraminal hernias, and hernias invading it entirely. This minimally invasive arthroscopic technique was applied in patients suffering from degenerative lumbar stenosis between L3 and S1. The first part of the study dealt with lumbar hernias. Of a total of 222 patients, 175 (78.82%) showed radicular canal invasion ranging between 50 and 90%. The disc level was L4–L5 in 59%, L5–S1 in 39%, and L3–L4 in 4%. Most of these hernias were lateral extrusions. However, the study also included protrusions and foraminal hernias, since they were large and technically difficult to operate on. In terms of distribution, 25 patients (14.28%) had protrusions and 120 (68.57%) extrusions, and in 30 patients (17.14%) hernias had migrated. Surgery was carried out by the biportal posterior approach through the flaval ligament. An irrigation pump was used and the structures were under permanent accurate arthroscopic visualization. Good results were obtained in 96%, fair in 3%, and poor in 1%. The second part of the study dealt with lateral stenosis. Drawing from the experience gained by experiments performed in 1993 on five cadavers and by translaminar epidural endoscopy since 1986, this surgical technique was designed to provide decompression by resection of the ventral zone of the articular facet and, in some cases, foramenostomy. Of the 19 patients treated, nine presented with pathology in one segment, nine in two segments, and one in three segments. All had lumbar and sciatic complaints, intermittent neurological claudication and predominantly lateral sensory motor deficit. The general results were good in 84% and fair in 16%.
Published Version
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