Transforaminal Percutaneous Endoscopic Surgery for Far Lateral Lumbar Intervertebral Disk Herniation

Abstract

Far lateral lumbar intervertebral disk herniation (FLLIDH) most commonly occurs far lateral to the intervertebral facet at L3-L4 and L4-L5 and accounts for 3.8% of all lumbar disk herniations. Traditional surgery for FLLIDH involves massive surgical trauma, damage to the spinal structure, and instability of the lumbar spine. The goals of this study were to perform a systematic review of the literature and investigate the clinical outcomes of transforaminal percutaneous endoscopic surgery in the treatment of FLLIDH. Between October 2010 and May 2012, fifteen patients diagnosed with FLLIDH underwent transforaminal percutaneous endoscopic surgery at the authors' institution to remove the herniated disk and release the nerve root. Pain was measured pre- and postoperatively with a visual analog pain scale (VAS), and postoperative outcomes were evaluated using MacNab's criteria. A PubMed database search was conducted for the systematic review. Median operative time was 100 minutes (range, 80-140 minutes). Median volume of intraoperative blood loss was 20 mL (range, 10-50 mL). Patients were followed postoperatively for a median of 6 months (range, 1-12 months). MacNab's criteria rated 12 (80.0%) surgical outcomes as excellent, 2 (13.3%) as good, and 1 (6.7%) as fair. The systematic review included 14 studies. Transforaminal percutaneous endoscopic surgery appears to be a safe and effective minimally invasive procedure for treating FLLIDH. However, as demand for this type of surgery increases, the possibility of intraoperative aggravated leg pain and compression injury of the ganglion must be considered.

Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence

“…Number of patients enrolled varied from 15 [ 26 ] to 400 [ 40 ]. Most common scales used for assessment and outcome were Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and MacNab criteria.…”

Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation

“…[1] It accounts for 7% to 12% of all cases of lumbar disk herniation. [2,3] The herniations are localized within or lateral to the intervertebral foramina, with the exiting nerve root compressed and displaced.…”

Endoscopic Spine Surgery: Distance Patients Will Travel for Minimally Invasive Spine Surgery

“…The development of improved endoscopes and instruments, the increased experience of endoscopic spine surgeons, and the continued demand by patients for minimally invasive spine techniques have led to an explosion of innovation in endoscopic spine surgical techniques since the first endoscopic views of a herniated nucleus pulposus were published by Kambin et al in 1988 (1). Published experience is available to patients and physicians on cervical approaches (2), thoracic approaches (3), and approaches to the thoracolumbar junction (4), as well as the treatment of far lateral disc herniations (5)(6)(7), reherniations (8)(9), extruded discs (10)(11)(12)(13), spondylolisthesis (14)(15), radiculopathy in the setting of instrumented fusion (16), discitis (17), discogenic back pain (18), and spinal tumors (19)(20).…”