Comparable effectiveness of transforaminal endoscopic spine system technique combined with selective nerve root block between far lateral lumbar disc herniation and central or paracentral herniation

Abstract

Objectives: This study aims to compare the clinical effectiveness of transforaminal endoscopic spine system (TESSYS) technique combined with selective nerve root block (SNRB) in treating patients with far lateral lumbar disc herniation (FLDH) and patients with central or paracentral herniation (C/PDH).

Patients and methods: Between June 2015 and June 2019, a total of 204 patients (80 males, 124 females; mean age: 62.3±5.4 years; range, 51 to 66 years) with a herniated disc were included. Of these, 22 consecutive adult patients with FLDH formed the FLDH group, while 182 patients with C/PDH formed the C/PDH group. Considering that FLDH was a rare type of LDH and occurred outside the spinal canal, the patients with LDH in the spinal canal (C/PDH) were selected as the controls in our study. All cases received ultrasound-guided SNRB to identify the diseased disc and treated by the TESSYS technique. Data including demographics, duration of operation, duration of hospital stay, surgical cost, complications, Visual Analog Scale (VAS) scores for the back and leg, and Oswestry Disability Index (ODI) scores and the modified MacNab criteria were analyzed.

Results: The FLDH group presented the similar clinical outcomes and costs with the C/PDH group. No significant differences in the VAS score, ODI score, and Macnab score were observed between the groups (p>0.05 for all). Both groups showed the significantly improved postoperative VAS scores on Day 3, at 1, 3, 6, and 12 months compared to baseline. The postoperative ODI scores at 6 and 12 months were also significantly improved (p<0.05). At the final follow-up at 12 months, the FLDH group showed the MacNab criteria rating excellent and good of 81.8% and C/PDH group showed 84.62%.

Conclusion: The FLDH patients presented the comparable clinical effectiveness with C/PDH patients. Based on these findings, the TESSYS technique combined with ultrasound-guided SNRB for FLDH is safe and feasible with caution, although the risk of nerve root injury may be worried.

Figure 1. Diseased discs were identified by ultrasoundguided selective nerve root block in all cases.

Figure 2. Case example of with FLDH who received TESSYS technique combined with SNRB. (a, b) Lumbar MRI and CT reconstruction showed a foraminal type FLDH at the disc herniation level L5-S1, compressing the L5 nerve root. (c, d) X-ray positive and lateral imaging of the sleeve insertion position during the operation. (e) L5 exit nerve root (shown by triangle) and the ligamentum flavum after forming (shown by five-pointed star). (f) MRI showed that the left intervertebral foramina was completely decompressed, and the nerve root compression was relieved at 1-year follow-up after surgery. FLDH: Far lateral lumbar disc herniation; TESSYS: Transforaminal endoscopic spine system; SNRB: Selective nerve root block; MRI: Magnetic resonance imaging; CT: Computed tomography.