“Inside Disc Out” Discectomy for the Treatment of Discogenic Lumbar Spinal Canal Stenosis under the Intervertebral Foramen Endoscope

• Published in: Orthopaedic surgery 2023-01, Vol.15 (1), p.355-361
• Main Authors: Sun, Shunqiang, Wang, Lu, Xue, Yuan
• Format: Article
• Language: English
• Subjects: Calcification; Clinical medicine; Discogenic lumbar spinal canal stenosis; Endoscopy; Hard disc protrusion; Intervertebral foramen Endoscope; Local anesthesia; Operative Technique; Operative Techniques; Spinal stenosis; Surgery; Surgical outcomes; Surgical techniques; “Inside disc out” discectomy
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13550

Objective Conventional posterior‐approach decompression surgeries have a higher risk of nerve root injury and dura laceration. We explore the therapeutic strategy and effect of “inside disc out” discectomy under intervertebral foramen endoscope technique for discogenic lumbar spinal canal stenosis (DLSS) treatment. Methods Twenty‐nine patients with DLSS in the responsible segment were treated with “inside disc out” discectomy under intervertebral foramen endoscope technique between October 2017 to October 2019. Lower limb and back pain were recorded before operation, and visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded for lower limb and back pain at 1, 3, 6, and 12 months postoperatively. The postoperative effects were evaluated using the modified MacNab method for all the patients. Results All 29 patients successfully completed the operation. The operation time was 75–120 min, with an average of 90 ± 17 min. Postoperative lumbar CT examinations of all the patients showed full decompression of the spinal cord with no residual pressure. The average follow‐up time for all the patients was 13 ± 3.5 months (12–18 months). The VAS score for lower back and lower limb pain was 7.52 ± 1.25 before the operation, and 1.80 ± 0.63, 1.33 ± 0.88, 1.07 ± 0.89, and 0.81 ± 0.51 at 1, 3, 6, and 12 months after the surgery, respectively. The Oswestry dysfunction index was 59.43 ± 10.04 before surgery and 29.67 ± 10.35, 21.13 ± 9.32, 14.52 ± 5.98, and 9.84 ± 4.68 at 1, 3, 6, and 12 months after the surgery, respectively. The VAS score and ODI index of low back and lower limb pain at different time points after the surgery were significantly improved compared to those before the surgery (P