Unilateral Radicular Pain Research Articles

Beyond traditional surgery for far lateral lumbar herniation : transforaminal full endoscopic discectomy

IntroductionThis study aimed to evaluate the clinical outcomes of transforaminal full-endoscopic lumbar discectomy (FELD) for treating lateral lumbar disc herniation. MethodsA retrospective single-center study was conducted at Centre Orthopédique Santy, Lyon, France, including 58 adult patients with foraminal or extraforaminal lumbar disc herniations who underwent surgery between October 2020 and January 2023. Inclusion criteria were patients with significant functional impairment due to unilateral radicular pain unresponsive to conservative treatment for over six weeks. Data on demographics, clinical characteristics, and outcomes were collected, evaluated preoperatively and at 12 months postoperatively using Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Macnab criteria. ResultsThe cohort had a mean age of 56.5 years and consisted predominantly of males, with 35 men (60%). Most herniations were at the L4-L5 level (29 patients, 50%). Significant improvements were observed in lumbar VAS (mean reduction of 1.9 points, p < 0.001), radicular VAS (mean reduction of 4.9 points, p < 0.001), and ODI (mean reduction of 41.9 points, p < 0.001) scores. Patient satisfaction was high, with 91% (53 patients) reporting excellent or good outcomes. The reoperation rate was 6.9% (4 patients). Linear regression analysis indicated that longer symptom duration and higher preoperative radicular VAS scores predicted greater satisfaction. ConclusionsTransforaminal FELD is a safe and effective technique for treating lateral lumbar disc herniation, offering high patient satisfaction. Symptom duration and preoperative radicular VAS scores are key predictors of positive outcomes. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.

Occupation-based demographic, clinical, and psychological presentation of spine pain: A retrospective analysis of 71,727 patients from urban India.

Although many studies have investigated the physical and ergonomic risks of spine pain in specific occupation groups, the literature is lacking on occupation-based clinical and psychological presentation in patients with spine pain. To analyze occupation-based variation in demographic, clinical, and psychological presentation in patients with spine pain. This retrospective study analyzed the clinical data of 71727 patients with spine pain visiting a chain of spine rehabilitation clinics. Demographic and clinical variables such as gender, age, affected site, symptom duration, clinical symptoms and presentation, pain intensity, disability, and STarT Back Screening Tool (SBT) risk were compared between 9 occupational groups. The service and sales workers (44%) and students (43.5%) groups had the highest percentage of patients who presented with central spine pain; military personnel had the highest percentage of patients who presented with unilateral radicular pain (51.5%); and the retired or unemployed group had the highest percentage of patients who presented with severe myotomal loss (grade≤3) (6%). Homemakers had significantly higher pain intensity and disability (p < 0.001) and had the highest percentage of patients who presented with severe pain (47%), severe and crippled disability (59.5%), and medium to high risk (59%) with SBT when compared to other occupational groups. Patients with spine pain showed variation in demographic, clinical, and psychological presentation based on their occupation. The findings of this study can be the basis for identifying risk factors for spine pain and helping plan preventive and treatment measures based on their occupation.

Biportal endoscopic posterior cervical foraminotomy with discectomy for unilateral radicular arm pain due to cervical herniated disc.

Recently, biportal endoscopic cervical approaches have been used to treat cervical degenerative disease. Biportal endoscopic posterior cervical foraminotomy with or without discectomy has the advantage of reducing damage to the normal tissues during surgery and enhancing fast recovery after surgery. The biportal endoscopic cervical approach was performed using two portals. The first portal was an endoscopic viewing portal for the spinal endoscope, and the other portal was a working portal for using surgical instruments. The author illustrates the surgical technique of biportal endoscopic posterior cervical foraminotomy with discectomy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23225.

Endoscopic Lumbar Disc Surgery Experience with the TESSYS Technique in 253 Case Series.

Background: Herniated lumbar disc (HLD) is a widespread medical problem which can require surgery. Minimally invasive surgical management can represent an extremely valuable option for patients suffering from HLDs. Transforaminal endoscopic lumbar discectomy is an alternative to classical microdiscectomy which was proposed more than two decades ago and has evolved technologically with time. Methods: The transforaminal endoscopic spine system (TESSYS) technique has been introduced in recent years and offers the advantage of performing a controlled foraminal augmentation with full nerve root protection. We started using this technique in 2016 and prospectively evaluated the results of endoscopic TESSYS-based operations performed in a three-year period until the end of 2019. Selection criteria were very strict, and we included only patients with unilateral radicular pain with no instability who failed conservative therapy. Out of the 253 patients operated on in that time span, 183 were available for follow-up evaluation. Results: After surgery, there was a clinically significant improvement of all symptoms which basically lasted in the long-term follow-up. Complications were limited and generally minor. Redo surgery with microdiscectomy was required only in four cases. Obesity did not play a clear negative role in patients' outcome. Conclusions: Endoscopic transforaminal discectomy with the TESSYS technique represents a valuable management option for patients harbouring unilateral herniated lumbar disc located laterally.

Clinical profile of herpes zoster in human immunodeficiency virus infected at a rural-based tertiary care center

Background: Due to the reactivation of the varicella-zoster virus, which had lainissed within sensory ganglions, herpes zoster (HZ) is typified by unilateral radicular pain and grouped vesicular eruption that is typically restricted to the dermatome innervated by a single spinal or cranial sensory ganglion. It is widely known that reactivation of varicella-zoster virus infection as HZ can cause morbidity in a human immunodeficiency virus (HIV)-positive host. Aims and Objectives: The aim of this study was to describe the clinical profile of HZ among HIV-positive patients in a rural tertiary care center. Materials and Methods: A prospective hospital-based study was conducted in a rural tertiary care hospital in Karnataka for duration of 24 months. All patients attending the outpatient department (OPD) of dermatology with clinical features of HZ and post-herpetic complications irrespective of their age and gender were included in the study. Data collection done in a semi-structured questionnaire on patient particulars as well as pre-existing co-morbidities was documented. Results: A cross-sectional study included 75 HZ patients attending OPD. Among the total 75 HZ patients, 11 were found to be seropositive for HIV infection. Seroprevalence among HZ was 14.6%. Among seropositive patients, the maximum belonged to the age group 41–60 years (63.3%). In the seropositive group, maximum cases (36.4%) occurred during summer while it was in the post monsoon season (39%) in the seronegative group. Conclusion: It is known that multidermatomal and severe pain is more commonly seen in HIV-infected patients than in the normal population. Many HIV-positive patients can present with a typical presentation of zoster as seen in our study.

Efficacy of Fenestration Technique for Lumbar Disc Excision in Pain Relief

Objective: To determine the outcomes of lumbar disc excision by fenestration technique for pain relief in lumbar radiculopathy due to prolapsed intervertebral disc. Methodology: This is a descriptive study conducted in a joint venture of orthopedic and neurosurgeons in a private hospital of Lahore. Study was completed in six months duration from July to December 2022. All patients presenting with lower back pain, straight leg raise test positive on &lt;60 degrees and prolapsed disc at the level of L4/L5 or L5/S1 L discs on MRI. Those with multilevel disc prolapse, previous history of spinal surgery, cauda equine syndrome and patients with lumbar stenosis were excluded from the study. All study patients were operated under general anesthesia in knee chest position. Efficacy of the procedure was determined using Dennis Pain Scale. Important findings were documented when patient was discharged. SPSS version 20 was used for statistical analysis. Results: 125 patients were studied including 73(58.4%) males and 52(41.6%) females. Patients with the age of 20-60 years were included in this study with the mean age of 47.3 ± 5.2 years. Most commonly involved disc level was L4-L5 in 77(61.6%) and L5-S1 in 48(38.4%) cases. Unilateral radicular pain was present in 94(75.2%) cases and bilateral pain was present in 31(24.8%) cases. According to Dennis Pain Scale out of 125 cases 78(62.4%) patients presented in Dennis pain scale P4 and among them complete recovery achieved in 70(89.7%) cases. Conclusion: Surgical intervention is necessary in selected patients with prolapsed intervertebral disc with chronic unilateral or bilateral radicular pain. Fenestration technique for disc excision is a very good procedure for prolapsed disc. Keywords: Sciatica, Disc Excision, Prolapsed Disc, Radiculopathy

Transforaminal versus interlaminar CT-guided lumbar epidural steroid injections: prospective study of 237 patients with unilateral radicular pain and up to 5years of follow-up.

To compare the efficacy of the transforaminal approach (TFA) versus the interlaminar approach (ILA) for CT-guided epidural steroid injection (CTESI) in the treatment of persistent lumbosacral radicular pain (LRP > 6weeks) with long-term follow-up. Patients were prospectively assessed for pain by visual analogue scale (VAS) and functional disability (Oswestry Disability Index, (ODI)) before treatment, then 6weeks (6W), 6months (6M), and 5years (5Y) after CTESI. Overall, n = 237 patients (TFA, n = 71 and ILA, n = 166) were included, and 96 patients had 5years of follow-up. Both groups showed a statistically significant improvement in VAS and ODI values at 6W (TFA, n = 60 and ILA, n = 146, P < 0.001 for both), at 6M (TFA, n = 34 and ILA, n = 96, P < 0.001 for both), and at 5Y (TFA, n = 32 and ILA, n = 64, P < 0.001 for both). No significant differences were observed between the two approaches in VAS or ODI decreases at 6W (P = 0.38 and P = 0.33 respectively), 6M (P = 0.13 and P = 0.51 respectively), or 5Y (P = 0.15 and P = 0.57 respectively). No major complications were noted. Outcomes after CTESI by ILA approaches are similar to those by TFA for the treatment of persistent LRP.

THE EFFECTIVENESS OF FORAMINAL ROOT BLOCK IN RELIEVING SCIATIC PAIN DUE TO LUMBAR DISC HERNIATION.

To evaluate the clinical profile, pain improvement, and the need for surgical interventions in patients undergoing transforaminal block with the use of corticosteroids and anesthetics. This is a prospective, randomized, double-blind study with 45 patients with unilateral radicular pain in their lower limbs and a single-segment lumbar disc herniation diagnosis. In the intervention group, transforaminal blocks with bupivacaine, dexamethasone, and clonidine were applied and in the control group, distilled water and bupivacaine. The Oswestry questionnaire was applied. We included 24 female (53.4%) and 21 male patients (46.6%). Of those with an occupation, 85.71% (n = 30) were relieved from their duties due to their illness and 14.29% (n = 5) continued to work with limitations. Those who underwent transforaminal block with an injection of corticosteroids, clonidine, and anesthetics showed immediate relief. However, such effect failed to alleviate patients' symptoms after three weeks. We observed that 52% of patients showed varying degrees of improvement. The control group experienced mild pain relief after one week, which also failed to last after three weeks. Moreover, 50% of patients improved in varying degrees. Further studies with larger samples, new epidemiological data, and longer follow-ups are necessary to validate our hypotheses. Level of Evidence II, Prospective Study.

Endoscopic lumbar foraminotomy for foraminal stenosis in stable spondylolisthesis.

Open decompression with fusion is the gold-standard surgical technique for spondylolisthesis. However, it may be too extensive for patients with foraminal stenosis with stable spondylolisthesis. The endoscopic lumbar foraminotomy (ELF) technique was developed as a minimally invasive surgical option for foraminal stenosis. Some authors have reported the outcomes of ELF for various spondylolistheses. However, few studies have demonstrated foraminal stenosis in advanced stable spondylolisthesis. This study aimed to describe the surgical technique and results of ELF for radiculopathy due to foraminal stenosis in patients with stable spondylolisthesis. Consecutive 22 patients who suffered from radiculopathy with spondylolisthesis underwent ELF. The inclusion criterion was unilateral radicular leg pain due to foraminal stenosis in stable spondylolisthesis. After the percutaneous transforaminal approach, foraminal decompression was performed using various surgical devices under endoscopic visualization. Surgical outcomes were measured using the visual analog pain score, Oswestry disability index, and modified MacNab criteria. Pain scores and functional outcomes improved significantly during the 12-month follow-up periods. The rate of clinical improvement was 95.5% (21 of 22 patients). One patient experienced a dural tear and subsequent open surgery. ELF can be effective in foraminal stenosis in stable spondylolisthesis. Technical points specializing in foraminal decompression in spondylolisthesis are required for clinical success.

Personal experience in intramedullary lesions, in adults

Background: Intramedullary spinal cord lesions (IMSCL) although they are rare, it generates invasion and destruction of the spinal cord. Such lesions must be diagnosed as early as possible, some have histological and genetic aggressiveness, generating severe functional neurological damage.&#x0D; Objective: To identify the optimal strategy for diagnosis and treatment in IMSC, to improve prognosis.&#x0D; Methods: A retrospective clinical study from 2001 to 2021, was performed on 33 adult patients (18 women, 15 men), diagnosed with magnetic resonance imaging with IMSCT. The most common topography was: thoracic 27 cases disposed between T2-T12, cervical 6 cases disposed between C2-C6, lumbar 2 cases at L1-L2. The most frequent symptoms in my cases were: unilateral radicular pain related to the tumour topography or bilateral diffuse burning pain, especially during the night; back and neck stiffness; paresthesia, motor disturbances with an ASIA score of 2-4, and severe atrophy especially in cervical topography, ataxia, initial retention, impotence and later loss of bowel and bladder function with incontinence. All patients were operated by the same senior neurosurgeon with at least 6 months of follow-up postoperatively. For functional outcome, the most important predictors are the preoperative neurological grade, and the high-grade IMSCT generating recurrence and reoperations.&#x0D; Results: The patients addressed the clinic for pain and neurological deficits; the topography of the intramedullary lesion was confirmed by MRI native / with contrast, ultrasonography, and spinal arteriography. Several histologic entities were recorded: ependymomas - 12 cases, astrocytomas - 8 cases, hemangioblastomas - 3 cases, cavernomas - 6 cases, metastases - 2 cases, germ cell tumour - 1 case, malignant peripheral nerve sheath tumour - 1 case. Gross total excision was performed in 25 cases, with no mortality. In eight cases recurrences were recorded requiring the resumption of surgical treatment. In all cases physiotherapy-rehabilitation approach was used, and the outcome was correlated with pre-operatory motor deficits severity, 3 patients with thoracic high-grade astrocytoma underwent stereotactic spine radiosurgery (SSR) with Cyberknife abroad, stopping tumour growth one year after.&#x0D; Conclusions: Intramedullary spinal cord lesions (IMSCL) are rare conditions, and MRI development allows an early diagnosis of these tumours. To adequately counselled patients, with minor preoperative deficits, real expectations concerning the functional outcomes, in benign tumours, and even anatomical healing should be based still on refinements of radical surgical excision. Actual radiotherapy techniques should be used in aggressive tumours.

Impact of Body Weight, Height, and Obesity on Selection of Skin Entry Point for Transforaminal Endoscopic Lumbar Discectomy.

Background Prospective evaluation of the effect of physical parameters like height, weight and abdominal girth on different skin entry points in transforaminal endoscopic lumbar discectomy (TELD) in lower lumbar discs. Methods This prospective study involved 174 patients with unilateral radicular pain or discogenic back pain, central, paracentral disc herniations and lateral canal stenosis at the level from L3 to S1 radiologically confirmed by magnetic resonance imaging (MRI) and failed conservative trial for 6 weeks. All patients underwent measurements of height, weight, body mass index (BMI), and abdominal girth preoperatively. All the four possible entry points, i.e., 45 to 45, posterolateral (PL), tip of spinous process (TOSP), and dorsum of the facet joint, were marked and point midway between PL and TOSP (PL-TOSP) skin entry was used. Results The change in the value, i.e., distance from midline of all the entry points with physical parameters like height, weight, BMI, and abdominal circumference was statistically significant. The visual analog scale score decreased from a preoperative value of 7.98 to 1.84 at 6 months follow-up. The Oswestry disability index score improved from 72.53 to 16.26. Conclusion The entry point in TELD is not a fixed value as it varies with the physical parameters like weight and abdominal girth of the patient. PL-TOSP is a safe entry point for common pathologies like central, paracentral herniations and lateral canal stenosis in lower lumbar levels and can be predicted preoperatively by proposed formula.

Ultrasound and nerve stimulator guidance lumbar transforaminal epidural block for the treatment of patients with lumbosacral radicular pain

Transforaminal epidural block (TEB) is a widely accepted technique and minimally invasive procedure for the treatment of lumbosacral radicular pain. This study aimed to evaluate the accuracy, efficacy, and safety of ultrasound and nerve stimulator guidance lumbar transforaminal epidural block (UNTEB) for the patients with unilateral lower lumbar radicular pain. The accuracy of this method was evaluated by fluoroscopy. Using UNTEB via axial and the in-plane approach technique was performed in 42 segments of 25 patients who presented with lumbosacral radicular pain to lower extremities. The contrast medium was injected to evaluate the needle tip at the intervertebral foramen under fluoroscopic guidance. The numerical rating scale was used to assess pain before and after treatment. The success ratio of UNTEB in L3/L4 level was 100%, in L4/L5 was 95.4% and in L5/S1 was 100%. The numerical rating scale (NRS) for lumbosacral radicular pain improved from a mean from 7.8 to 2.8 1 day after procedure (p = 0.01) and from a mean from 7.8 to 2.4 1 week after UNTEB (p = 0.01). None of our subjects experienced any complications during and after the procedure. UNTEB with fluoroscopic validation is an accurate, effective, and safe method for short-term pain relief of the patients with unilateral lumbosacral radicular pain.

One Year Results from a Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain

One Year Results from a Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain

Factors Associated with Treatment Success After Interlaminar Epidural Steroid Injection for Cervical Radicular Pain.

To investigate the demographic, clinical and radiological findings associated with treatment success after interlaminar epidural steroid injection (ILESI) in radicular pain induced by cervical disc herniation. In this retrospective study, the data of patients who received cervical ILESI between January 2017 and June 2021 were screened. Of 223 patients, 92 with unilateral radicular neck pain due to cervical disc herniation were included. Demographic data, symptom duration, and numerical rating scale scores at baseline, at three weeks, three months, and six months after treatment were collected from the medical records of the patients. Disc herniation level, cervical axis, disc height, presence and degree of spinal canal and neural foraminal stenosis, vertebral endplate signal change, and definitive presence of uncovertebral and facet osteoarthritis were evaluated using cervical spine magnetic resonance imaging. Treatment success was determined as ?50% reduction in pain scores at six months compared to baseline. Data of 92 patients (27 men, 65 women) were included. The mean age was 50.82 ± 10.22 years, and the median symptom duration was 12 (4.25 to 20) months. At six months after ILESI, treatment was successful in 58 (58.7%) patients and unsuccessful in 34 (41.3%) patients. Multivariable logistic regression analysis was performed to identify the factors associated with treatment success at six months post-injection. In the final model, neural foraminal stenosis (non-severe vs. severe) and spinal canal stenosis (non-severe vs. severe) were significantly associated with the treatment success (OR=3.02, 95% CI=1.40?10.95, p=0.009; OR=5.31, 95% CI=1.77?15.85, p=0.003). Treatment success of cervical ILESI at six months is favorable. However, the presence of severe neural foraminal and spinal canal stenosis is associated with a reduced likelihood of treatment success.

Ultrasound and nerve stimulator guidance lumbar transforaminal epidural block with fluoroscopic validation study for the treatment of patients with unilateral lumbosacral radicular pain

Ultrasound and nerve stimulator guidance lumbar transforaminal epidural block with fluoroscopic validation study for the treatment of patients with unilateral lumbosacral radicular pain

Herpes zoster following Streptococcus suis infection: A case report

Background. Herpes zoster is a disease caused by reactivation of endogenous viruses that cause local dermatomal disorders characterized by unilateral radicular pain and vesicular dermatomal eruption. Some of the factors that responsible for reactivation of the herpes zoster virus are older age and low immune status. Case presentation. A 54-years-old presenting with meningitis after consumed a raw pork. Five days later developed herpes zoster. Conclusions. Herpes simplex reactivation in Streptococcus suis infection might relate to low immune system caused by the poor immune response to antibody and the use of high-dose systemic steroid.

Calcified lumbar disc prolapse technical note and management algorithm: a prospective study

Background: The literature lacks sufficient data about management of symptomatic calcified lumbar disc prolapse. The authors introduced a practical algorithm for surgical management of patients after failed conservative measures. Methods: A prospective study of 32 patients was conducted between 2012 to 2018. Patients had symptomatic calcified lumbar disc prolapse. Eight patients had unilateral radicular pain, four patients had unilateral claudication pain, nine patients had bilateral claudication pain, and 11 patients had mechanical back pain together with claudication symptoms. Preoperative motor examination revealed one patient with preoperative unilateral foot drop, two patients had preoperative unilateral weak ankle dorsiflexion, and 11 patients had weak extensor halluces longus extension. Fifteen patients had fusion surgery, 11 patients had unilateral decompression, and six patients had bilateral decompression surgery. Functional assessment of patients was done by Oswestry Disability Index (ODI), and radicular pain was assessed by visual analog scale (VAS). Results: There were 19 men and 13 women. The mean age was 39.2 yr. The mean operative time for unilateral decompression was 59 min, and bilateral decompression was 80 min. The mean operative time for fusion surgery was 126.4 min. Three patients had intraoperative dural tears. One patient had postoperative ankle dorsiflexion in comparison to preoperative examination, four patients had immediate postoperative lower-limb dysesthesia. The ODI and VAS postoperative improvements were statistically significant when compared with the preoperative values. The mean follow-up was 28.4 mo. Conclusions: The results of this study were encouraging in the adoption of the proposed algorithm for management of symptomatic calcified lumbar disc prolapse. Level of Evidence: Level III.

A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results.

Compare the effectiveness of catheter-directed cervical interlaminar epidural steroid injection (C-CIESI) with triamcinolone to cervical transforaminal steroid injection (CTFESI) with dexamethasone for the treatment of refractory unilateral radicular pain. Prospective, randomized, comparative trial. Primary outcome: proportion of participants with ≥50% numeric rating scale pain score reduction from baseline "dominant pain" (the greater of arm vs neck) at one month postinjection. Secondary outcomes: ≥30% Neck Disability Index (NDI-5) reduction and Patient Global Impression of Change (PGIC) response indicating "much improved" or "very much improved." One hundred twenty participants (55.6% females, 52.3 ± 12.5 years of age, BMI 28.2 ± 6.5 kg/m2), were enrolled. The proportions of participants who experienced ≥50% pain reduction at one, three, and six months were 68.5% (95% CI = 54.9-79.5%), 59.3% (95% CI = 45.7-71.6%), and 60.8% (95% CI = 46.7-73.2%), respectively, in the C-CIESI group compared with 49.1% (95% CI = 36.4-62.0%), 46.4% (95% CI = 33.8-59.6%), and 51.9% (95% CI = 38.4-65.2%), respectively, in the CTFESI group. The between-group difference at one month was significant (P = 0.038). The proportions of participants who experienced a ≥30% NDI-5 score improvement were 64.0% (95% CI = 49.8-76.1%) and 54.9% (95% CI = 41.1-68.0%) in the C-CIESI and CTFESI groups (P = 0.352). Participants reported similar PGIC improvement in both groups: At six months, 53.2% (95% CI 38.9-67.1%) and 54.5% (95% CI = 39.7-68.7%) of the C-CIESI and CTFESI groups reported being "much improved" or "very much improved," respectively (P = 0.897). Both C-CIESI with triamcinolone and CTFESI with dexamethasone are effective in reducing pain and disability associated with refractory unilateral cervical radiculopathy in a substantial proportion of participants for at least six months.

Spinal Melorheostosis: A Rare Cause for Thoracic Radiculopathy.

Symptomatic spinal melorheostosis is a rare entity, and its surgical management is even rarer. Our objective is to highlight the importance of considering spinal melorheostosis among the differential diagnosis of thoracic radiculopathy. We report a case of melorheostosis involving the T9 vertebra presenting with unilateral radicular pain managed surgically by decompression and posterior stabilization. Our patient had complete symptomatic relief following surgical resection without any perioperative complications. Spinal melorheostosis, although rare, forms an important differential diagnosis in patients presenting with thoracic radiculopathy where surgical management can be a viable option in cases refractory to conservative treatment. 5.

SURGICAL OUTCOME OF PERCUTANEOUS ENDOSCOPIC INTERLAMINAR LUMBAR DISCECTOMY TECHNIQUE

Background: Minimally invasive lumbar surgeries are becoming more popular and a routine around the world. Although good surgical outcomes have been reported for the endoscopic approach to treat lumbar disc herniation (LDH), the procedure still appears to be relatively difficult so operative failures and complications may be occurred. Objective: To assess the outcome of lumbar spinal endoscopic discectomy by Destandaeu technique as minimally invasive approach in Al Azhar experience. Patients and Method: Thirty five consecutive patients proved to have lumber disc prolapse, were treated with percutaneous endoscopic lumbar discectomy through interlaminar approach discectomy by Destandau's technique using Endospine Karl Storz system between September 2017 and October 2019 at the Neurosurgery Department, Al-Azhar University Hospitals. All patients included in this study have lumbar disc prolapse fulfilled the following criteria: Unilateral Radicular pain correlated with MRI finding, failure of conservative measures for at least 6 weeks, single level disc prolapse, and disc prolapse was central or paracentral. Follow up for 6 months postoperative and Clinical outcomes were assessed by using Visual Analogue Scale (VAS) score (for Mean pre- and postoperative pain score measurement) and Oswestry Disability Index (ODI), Patients Satisfaction measured by Modified Macnab Criteria at 6 months postoperative, Time of return to work, Recurrence or persistence of symptoms which need revision open surgery. Results: The mean age was 37.5 years, the mean operative time was 90 minutes, and the mean length of follow-up was 5 months. The mean hospital stay for endoscopic discectomy was 36 hours. There was a significant reduction in the severity of back pain and lower limb symptoms measured by (VAS) (ODI) in 87% (30 patients) at 6 months. The recurrence rate was 8.5% (3 patients) and persistent symptoms without improvement occurred in 5.7 % (2 patients) who subsequently underwent revision surgery. Most Patients returned to their previous occupation after surgery at a mean time of 35 days. Conclusion: Endoscopic discectomy by Destandau's technique for lumbar disc prolapse in properly selected patients was safe and minimally invasive technique.