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

Abstract

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.

Full-Endoscopic Extraforaminal Approach for Extraforaminal Herniated Intervertebral Disc Disease: Exploring Challenging Case

“…til it reached the base of the SAP. While inserting the needle into the lateral aspect of the SAP, we infiltrated approximately 5 to 10 mL of 1% lidocaine into the muscle layer [12]. Upon reaching the lateral aspect of the base of the SAP, tactile feedback from the bone was detected (Figure 1A), and the needle position was confirmed using fluoroscopy assistance.…”

Strategies to Improve Neurological Safety in Full-Endoscopic Lumbar Fusion Surgery: A Comprehensive Review

“…Postoperative computed tomography scans clearly showed an enlarged intervertebral foramen, facilitating the safe insertion of a working channel [35,36]. In clinical research, the consistent recommendation of foraminoplasty aims to expand the surgical area by resecting the ventral part of the SAP, thereby reducing nerve root irritation [37][38][39][40][41]. This evidence underscores the critical role of foraminoplasty in FE fs-TLIF, not only in improving the surgical success rate but also in ensuring comprehensive disc space access and the safe- In the evolutionary trajectory of FE fs-TLIF, Jacquot and Gastambide [42] reported a frequent postoperative complication with an incidence of 36% in 2013.…”

“…It is essential to execute precise local anesthesia while avoiding infiltration of the exiting nerve root, as this could potentially mask the symptoms of NRI [57]. Tai et al [37] recommend a specific technique involving the administration of 3 to 5 mL of 1% lidocaine at the subcutaneous and fascia layers, followed by 5 to 10 mL of 1% lidocaine infiltration from the muscle layer to the junction of the pedicle and SAP. This injection route minimizes the risk of nerve block of the exiting root.…”

“…This injection route minimizes the risk of nerve block of the exiting root. Finally, the needle is inserted into the ventral SAP, and 5 to 10 mL of 0.5% lidocaine is administered to block the sensation of the facet joint [37]. By employing appropriate local anesthesia, patients can detect any dysesthesia or paresthesia sensations during the operation, allowing for immediate intervention, such as stopping the procedure or adjusting the surgical cannula, to help reduce the incidence of injury to the exiting nerve root [35,69].…”