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Observational Study
. 2018 Apr;97(17):e0585.
doi: 10.1097/MD.0000000000010585.

Full-endoscopic discectomy via the interlaminar approach for disc herniation at L4-L5 and L5-S1: An observational study

Wenbin Hua  1 , Ji Tu, Shuai Li, Xinghuo Wu, Yukun Zhang, Yong Gao, Xianlin Zeng, Shuhua Yang, Cao Yang
Affiliations
Observational Study

Full-endoscopic discectomy via the interlaminar approach for disc herniation at L4-L5 and L5-S1: An observational study

Wenbin Hua et al. Medicine (Baltimore). 2018 Apr.

Abstract

The purpose of this retrospective study was to investigate the clinical outcomes of full-endoscopic discectomy via the interlaminar approach in the treatment of lumbar disc herniation (LDH) at L4-L5 under general anesthesia.Eighty-four patients who underwent full-endoscopic discectomy via the interlaminar approach at L4-L5 or L5-S1 were included. Durations of surgery, intraoperative radiation, postoperative bedrest, and hospitalization as well as perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and the Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 12 months postoperatively.The mean durations of surgeries in surgeries involving L4-L5 and L5-S1 were 69.8 ± 18.8 and 67.0 ± 20.1 minutes, respectively. The mean durations of intraoperative radiation were 1.2 ± 0.3 and 1.3 ± 0.3 seconds, respectively. The mean VAS and ODI scores improved significantly postoperatively compared with the preoperative scores. The perioperative complications included intraoperative epineurium injury in 3 cases without nerve injury, cerebrospinal fluid leakage, or cauda equina syndrome. The total recurrence rate after 12 months follow-up was 1.2% (one case at L5-S1).Full-endoscopic discectomy via the interlaminar approach could be considered as one of the alternative options for the treatment of LDH at L4-L5.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Full-endoscopic discectomy via the interlaminar approach performed in the lateral position.
Figure 2
Figure 2
The procedure of full-endoscopic discectomy via the interlaminar approach performed in a 32-year-old female patient diagnosed with lumbar disc herniation at L4-L5. (A and B) preoperative magnetic resonance imaging (MRI) shows lumbar disc herniation at L4-L5; (C and D) intraoperative anteroposterior and lateral fluoroscopy to confirm the interlaminar space; (E) ligamentum flavum; (F) ligamentum flavum incised; (G) cranial lamina resected by the direction-variable drill; (H) dural sac exposed; (I) cranial lamina partial resected with the dural sac and herniated disc exposed; (J) dural sac, traversing nerve root, and axilla after decompression; (K and L) MRI 10 days after the surgery shows herniated lumbar disc decompressed. MRI  =  magnetic resonance imaging.
Figure 3
Figure 3
The procedure of full-endoscopic discectomy via the interlaminar approach performed in a 33-year-old male patient diagnosed with lumbar disc herniation at L5-S1. (A and B) preoperative magnetic resonance imaging shows lumbar disc herniation at L5-S1; (C and D) preoperative computed tomography (CT) shows herniated and calcified lumbar disc at L5-S1; (E) interlaminar space exposed; (F) cranial lamina resected by the direction variable drill; (G) herniated disc exposed and extracted; (H) a radiofrequency electrode is applied to control bleeding; (I and J) dural sac, traversing nerve root, and axilla after decompression; (K and L) CT one day after the surgery shows herniated and calcified disc decompressed. CT = computed tomography.
Figure 4
Figure 4
The learning curve in the 2 groups.
Figure 5
Figure 5
The mean values of visual analog scale (VAS) scores for leg and back pain, and Oswestry disability index (ODI) scores. Preop, preoperative; postop, postoperative. ODI = Oswestry disability index, VAS = visual analog scale.
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