Transforaminal Endoscopic L5–S1 Discectomy Case Series One Year Experience

Abstract

With recent advances in minimally invasive surgery, full endoscopic discectomy has been more involved, not only the interlaminar approach but also the transforaminal. Transforaminal endoscopic surgery (TFES) can decompress the nerve root with less insult to surrounding soft tissues compared to interlaminar or open approaches, resulting in less postoperative pain, reduced length of stay, and early return to work. We reviewed retrospectively the clinical presentation of 20 patients with symptomatic L5-S1 disc prolapse with unilateral radicular pain whom underwent Transforaminal endoscopic surgery (TFES). Clinical and satisfactory outcomes were assessed using the visual pain analogue scale (VAS), Oswestry disability index (ODI) at follow up period 6 months postoperative. This study included 20 patients 14 males (70%) and 6 females (30%) Male to female ratio was 2.3: 1 with a mean age of 42.38 years ± 13.1 (range 25- 58 years). The preoperative mean VAS scores for radicular pain significantly decreased from 8.1± 14 to 2.8± 1.1 at 6 months follow-up (p = 0.0034). There was significant difference in VAS scores for back pain (5.7± 2.1) preoperatively to 1.9± 2 (p=0.02). ODI decreased from 57±2.5 to 11±10.5. Average length of stay was 1-3 days (1±0.5). TFES can be done for herniated L5-S1 discs bypassing the iliac crest barrier, by using an appropriate suprailiac trajectory and tailoring the entry point based on the patient’s body mass index guided by fluoroscopy.