The microendoscopic approach for far lateral lumbar disc herniation: a preliminary series of 33 patients

Abstract

Abstract Background Far lateral lumbar disc herniation (FLLDH) compresses the nerve root at the same level. The laterally herniated disc fragment typically could not be exposed by the standard posterior hemi-laminectomy technique, and a total facetectomy including wide bone removal is usually mandatory for good exposure and removal of the herniation but simultaneously increasing the risk of instability. Objective In the present study, the author presents his initial 4-year experience and surgical outcome in treatment of far lateral lumbar disc herniation with a posterior endoscopic approach. Methods This study was carried out in the period between February 2011 and January 2015, where 33 consecutive patients with symptomatic FLLDHs underwent a posterior endoscopic lateral approach for resection of the herniation. The mean age was 39.3 years, range 26–59 years. Patients were followed up for 4 years (mean follow-up was 19.9 months, range 3–47 months). Patients had their clinical outcomes reviewed and evaluated in terms of pain by visual analog scale (VAS) and in terms of functional outcome by modified Macnab criteria (MMC). Results Mean operative time was 91 min (range 55–166 min). At initial follow-up, according to MMC (3 months postoperative), 86% of patients were pain-free (28/33) and considered their postoperative status as excellent and 14% as good (5/33), and no patients reported a fair or poor outcome. There were no new postoperative neurological deficits or major complications. There were three cases of accidental medial facetectomy due to excess bony work, a single case of dural tear, and a single case that had a transient postoperative neuralgia that persisted for 2 weeks. Conclusions FLLDH can be treated adequately with the reported microendoscopic approach. The technique is associated with marked improvement in back pain and lower limb symptoms, as well as a short length of hospitalization and other benefits of minimal invasiveness. Although a transitory learning curve is necessary, the endoscope in general was safe in handling bimanually and allowed adequate mobility and visualization.