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

#186 A Comparative Outcome Evaluation of Lumbar Transforaminal Endoscopic Discectomy versus Micro-lumbar Discectomy for Lumbar Disc Herniation in a Single Specialty Spine Practice

Lumbar Therapies and Outcomes

Poster Presented by: A.T. Yeung

Author(s):

A.T. Yeung (1,2)
Y. Zheng (1)
C. Yeung (1)

(1) Desert Institute for Spine Care, Phoenix, AZ, United States
(2) University of New Mexico School of Medicine, Albuquerque, NM, United States

Abstract

Introduction: The outcome of MIS techniques for lumbar disc herniation treated by transforaminal endoscopic discectomy (SED) versus micro-lumbar discectomy (MLD) were compared.

Method: 250 consecutive patients who underwent transforaminal “selective endoscopic discectomy” (SED) and 50 consecutive patients who underwent micro-lumbar discectomy (MLD) were compared using (VAS) and (ODI). The procedure MLD vs SED was a shared patient/surgeon decision. The MLD procedure was with microscope magnification while the SED procedure was with endoscopic foraminal visualization. Data was collected and recorded at each office visit and at final follow up before discharge from care. Data collection was by a spine fellow undergoing a one year spine fellowship. All procedures were performed in a spine ambulatory surgical center owned by ta single specialty spine practice. Average follow up was, minimum 12, average 38 months.

Results: 50 Cases of MLD: L4-5=15, L5-S1=35. Average VAS=6.5-1.7, Average ODI 44%-30%. Complications=1 seroma,1durotomy. Patients receiving MLD was for extruded, migrated, or sequestered HNP believed better for MLD and not appropriate for SED. Patients in this spine practice,known nationally for SED, usually chose SED over MLD when given a both choices by the operating surgeon. SED included extruded, migrated, sequestered HNP at all levels felt possible by the operating surgeon. The SED group numbered 250, with 309 total levels. Average VAS was 6.6-2.5 and ODI was 46%-32%. 37 patients (15%) developed temporary dysesthesia in the 2 week post-operative period. Improvement in VAS and ODI was comparable to MLD. Patient satisfaction in the endoscopic group was high in spite of dysesthesia, usually occurring and predicted when furcal nerves were identified and occasionally sacrificed, and inflammatory membranes were ablated. The surgeon factor played a role, as many patients selected the practice due to its surgical track record and reputation for MIS spine surgery. Each surgeon presented alternatives to the patient, and the decision with respect to technique was a joint decision taking into account the patient´s needs.

Discussion: In spite of dysesthesia not usually experienced by MLD patients, patient satisfaction remained high, as the patient's ultimate results were similar. The more difficult extruded herniations where access was not possible or limited due to anatomic considerations were encouraged to chose MLD. The practice had experienced surgeons for both techniques.

Conclusion: Both procedures produced high patient satisfaction and was equally effective. A few patients who crossed over to an open MLD approach was not in this series, but is mentioned to be complete. There were patients who sought a less invasive transforaminal approach was also not in this series, with most patients from outside the practice. There were not enough numbers to be powered for statistical analysis. Crossovers consisted of a few recurrent herniations or retained, incomplete decompression from the foraminal endoscopic approach known to occasionally happen.