Percutaneous Transforaminal Endoscopic Lumbar Discectomy: Early Experience of the First Fifty 50 Cases

Abstract
Background: Many kinds of surgical approaches from standard discectomy, microdiscectomy, percutaneous inter-laminar and transforaminal endoscopic discectomy have been in use for treatment of prolapsed intervertebral disc. Transfo-raminal endoscopic discectomy through a safe triangle (Kambin triangle) is a stitchless minimal invasive approach, doesn't require muscle splitting, can be done under local anaethesia with short hospital stay and minimal complication.
Aim of Study: The aim of this study is evaluation of early experience of transforaminal endoscopic lumbar discectomy, surgical technique, complications, overall results in single and multilevel lumbar disc herniation.
Patients and Methods: A retrospective study involved fifty patients with low back pain and unilateral sciatica due to prolapsed intervertebral disc were treated with endoscopic transforaminal discectomy at Zagazig University Hospitals, Al-Helmia and Al-Agoza Military Hospitals from Jan 2016 to June 2017 (35 patient under local, 15 patients under general anesthesia). Preoperative clinical assessment of the patients has done using visual analogue score (VAS) and Oswestry Disability Index (ODI) and follow-up was done at 1, 6, 12, months postoperatively. Surgery done by surgeons have never practicing endoscopic transforaminal approach before.
Results: Using Modified MacNab's criteria, good to excellent outcome was noted (45 patients, 90), fair outcome (2 patients, 4%) and poor results (3 patients, 6%). No major complications were noted, discitis in (2 patients, 4%), dysae-thesia (3 patients, 6%), recurrent disc prolapsed (3 patients, 6%), dural tear in (2 patients, 4%), no wound infection reported, mean operative time 55 minutes, mean hospital stay (12 hours, 4 days), mean return to work.
Conclusion: Since the introduction of percutaneous pos-terolateral approach by Kambin in the year of 1973, for treatment of herniated LDP, the procedure has advanced over the last decades and becoming more popular as the treatment of choice for treatment of herniated lumbar disc in selected cases.
Percutaneous transforaminal discectomy is a relatively safe and successful alternative approach for treatment of lumbar disc prolapse and associated sciatica, although micro-discectomy still remains the gold standard approach.