531 - A Comparative Outcome Evaluation of Lumbar Transforaminal Endoscopic D...

#531 A Comparative Outcome Evaluation of Lumbar Transforaminal Endoscopic Discectomy (SED) versus Micro-lumbar Discectomy for Lumbar Disc Herniation

Lumbar Therapies and Outcomes

Poster Presented by: A. Yeung

Author(s):

A.T. Yeung (1)
C.A. Yeung (1)
J. Field (1)

(1) Desert Institute for Spine Care, Phoenix, AZ, USA

Abstract

Purpose: The objective of this study was to compare the clinical outcome of patients with lumbar disc herniation treated by transforminal endoscopic discectomy versus micro-lumbar discectomy.

Study Design/Setting: This is a retropective review of outcome data in patients with lumbar disc herniation treated by transforaminal endoscopic discectomy versus micro-lumbar discectomy by 3 surgeons, all with foraminal endoscopic experience in an outpatient setting. The senior surgeon had limited his practice to transforaminal endoscopic surgery for the past 20 years, attracting patients seeking the transforaminal approach.

Method: The clinical outcome of 250 consecutive patients who underwent “inside-out” transforaminal “selective endoscopic discectomy” (SED) was compared with 50 consecutive patients who underwent micro-lumbar discectomy (MLD) . All patients were tracked by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcome measures. A clinical rating by modified MacNab criteria summarized the outcome. The procedure of decompression and discectomy chosen was a shared patient/surgeon decision. Data was collected and recorded at the initial office visit, preoperative and postoperative visits, as well as final follow up. All procedures were performed ln an ambulatory surgical center, owned by the practice. All patients were discharged home the same day. The average follow up time was, minimum 12, average 38 months.

Results: 50 Cases of MLD : L4-5=15, L5-S1=35. Average VAS=6.5, Average ODI 44%. Improvement was 3.8 and 30% respectively. Complications=1 seroma, 1 durotomy. Patients receiving MLD was due to surgeon preference, mostly for extruded or sequestered HNP. Patient satisfaction was 92%. Patients in this spine practice, however, sought and chose SED when given the choice by their surgeon. The SED group numbered 250, with 309 total levels. Average VAS was 6.6 and ODI was 46%. Improvement in the SED group was 6.6-2.5=4.1 ODI=32%. Endoscopic decompression included foraminoplasty for lateral stenosis. In the endoscopic group, (15%) developed dysesthesia in the 2 week post-operative period. Dysesthesia resolved within 1 week to 6 months, In spite of the surgeon taking on more complex degenerative spine problems in patients who were also candidates for decompression and fusion. Improvement in VAS and ODI was comparable to MLD at 4.1 and 32% respectively. Patient satisfaction was high, since many were able to avoid fusion and none were worse.

Conclusion: There may be a favorable patient / surgeon bias involved since many patients self selected and sought the endoscopic technique even when decompression and fusion was suggested and offered, but refused. In spite of the risk of dysesthesia not usually experienced by MLD patients, patient satisfaction remained high, because patients were advised that dysesthesia as an unavoidable temporary consequence of the foraminal surgical approach at pre-operative counseling. The more difficult extruded herniations where access was limited due to anatomic considerations such as extruded, sequestered herniations at L5-S1 made up the majority of the patients acquiescing the micro-lumbar discectomy. This study confirms the general consensus that MIS surgery provided comparable results with less surgical morbidity. The surgeon factor is one consideration that must be considered by each surgeon as the a share surgical decision becomes the desired concept, and surgeons sought after by patients must select the method that considers patient choice with surgeon concurrence.