Endoscopic Transforaminal Discectomy for Primary Lumbar Disc Herniation ??? Early Results and Own Experience

Introduction. Radicular syndrome manifested by lower limb pain and low back pain is a common clinical problem. Operative treatment usually consists of decompression with microdiscectomy from the posterior approach. In the last years minimally-invasive techniques are becoming more popular, one of them is transforaminal posterolateral endoscopic discectomy. Aim of paper. Aim of paper is to present the clinical results of patients with disc disease treated with endoscopic transforaminal discectomy. Authors also evaluate the number complication rate and analyze the risk factors. Material. Material consists of 57 patients treated surgically during a 20 months period, who underwent lumbag spine decompression and endoscopic transforaminal discectomy. There were 22 women and 35 men. Mean age at surgery was 38 years (min.17- max.79). Follow-up period longer than 3 months was in 52 patients (91%), longer than 6 months 47 patients (82%). Methods. We evaluated lower leg and low back pain intensity using the VAS score preoperatively and at follow-up controls. Above that intra-operative data were analyzed: length of surgery, approach side, operated level. Next the presence of any intra-operative and postoperative complications was analyzed and complication rate was calculated. Results. Pain intensity according to VAS score, evaluated 3 months postoperatively, for low back pain was 3.5 – decrease of 5 points compared with the pre-operative value. VAS score for leg pain was mean 2.5 – decrease of 6 points. There were 39 procedures on L5/S1 level, 17 on L4/L5, 1 on L3/L4, and 1 on L2/L3 level. Mean time of surgery was longest on L5/S1 level - 62 min. (min.40-max.90). Complications were present in 12 patients. 10 reoperations on L5/S1 level were performed, 2 on L4/L5 level. Rate of reoperation for the whole group was 21%. Conclusion. Transforaminal posterolateral endoscopic discectomy is an effective procedure in the treatment of primary disc herniation. Risk of major complications is low, and the method does not prevent other, more complex procedures when needed.