OUTCOMES OF TRANSFORAMINAL ENDOSCOPIC DISCECTOMY FOR LUMBOSACRAL DISC HERNIATION

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Abstract

Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.

The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in comparison with microdiscectomy (MD) and to specify factors determining complications and failures.

Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.

Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9%) which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.

Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic procedure are associated with technique drawbacks as well as with mistakes in planning and performing the approach. Congenital alignment of lumbar spine with specific patterns of facets and foramina anatomy dictate technical difficulties with transforaminal approach. 

About the authors

I. V. Volkov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Nikiforov Russian Center of Emergency and Radiation Medicine

Author for correspondence.
Email: ivanvolkov@yandex.ru

Ivan V. Volkov — Cand. Sci. (Med.), Senior Researcher, Vreden Russian Research Institute of Traumatology and Orthopedics; Neurosurgeon, Nikiforov Russian Center of Emergency and Radiation Medicine

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

I. Sh. Karabaev

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: fake@neicon.ru

Igor Sh. Karabaev — Cand. Sci. (Med.), Head of Neurosurgery Department 

54, ul. Optikov, St. Petersburg, 19734

Russian Federation

D. A. Ptashnikov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Dmitry A. Ptashnikov — Dr. Sci. (Med.), professor, Head of Spine Surgery and Oncology Department, Vreden Russian Research Institute of Traumatology and Orthopedics; Head of Traumatology and Orthopedics Department, Mechnikov North Western State Medical University 

St. Petersburg

Russian Federation

N. A. Konovalov

Burdenko National Scientific and Practical Centre for Neurosurgery

Email: fake@neicon.ru

Nikolai A. Konovalov — Dr. Sci. (Med.), professor, Head of Spinal Neurosurgery Department 

41, Kirochnaya ul., St. Petersburg, 191015

Russian Federation

K. A. Poyarkov

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: fake@neicon.ru

Konstantin A. Poyarkov — Neurosurgeon 

54, ul. Optikov, St. Petersburg, 19734

Russian Federation

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