Transforaminal percutaneous endoscopic lumbar discectomy: outcome and complications in 270 cases

BACKGROUND: The endoscopic approach was introduced in the clinical practice in 1980 with the aim to remove the prolapsed disk and free the compressed nerve using the least disruptive surgical technique, assuring in the same time, the resolution of the symptoms and a faster return back to normal life activity. Over the years, thanks to an extraordinary technical improvement either in terms of quality of images or development of many different tailored instrumentations there has been a huge spreading of the endoscope use across the different surgical fields. For this reason, the transforaminal percutaneous endoscopic lumbar discectomy can be considered, at the moment, the least invasive procedure for the removal of lumbar disc prolapsed. The aim of this study was to analyze the clinical outcome and complications rate on a large cumulative series operated on in two years period.METHODS: We presented a retrospective series involving 270 cases of lumbar disk herniation managed surgically only by a percutaneous transforaminal endoscopic technique in two units and by two surgeons. All patients had a minimum follow-up of 6 months. Primary study end points were evaluation of outcomes using the visual analogue scale and Oswestri Disability Index preoperatively and at 3, 6 and 12 months as well as the complications and the recurrence rates.RESULTS: Our results, with a positive outcome around 93%, confirmed the effectiveness of transforaminal percutaneous endoscopic discectomy in the treatment of lumbar disc herniation when compare to open microdiscectomy. Also, the complications (5.5%) and the recurrence rate (4.1%) could be considered within the standard results.CONCLUSIONS: The transforaminal percutaneous endoscopic lumbar discectomy is a safe and effective procedure to treat lumbar disc prolapsed. Surgical experience and correct patients' selection are crucial factors affecting the outcome.