Transforaminal endoscopic lumbar discectomy with two-segment foraminoplasty for the treatment of very highly migrated lumbar disc herniation: a retrospective analysis

• Published in: BMC surgery 2024-04, Vol.24 (1), p.113-113, Article 113
• Main Authors: Zhang, Yao, Song, Jipeng, Lin, Wancheng, Ding, Lixiang
• Format: Article
• Language: English
• Subjects: Blood; Complications; Computed tomography; CT imaging; Diskectomy - methods; Diskectomy, Percutaneous - methods; Endoscopy; Endoscopy - methods; Epidural; Epidural hematoma; Foraminoplasty; Fractures; Fragments; Health services; Hematoma; Humans; Iatrogenic Disease; Intervertebral Disc Displacement - surgery; Intervertebral discs; Investigations; Lumbar region; Lumbar Vertebrae - surgery; Magnetic resonance imaging; Medical imaging; Medical research; Medicine, Experimental; Middle Aged; Migrated lumbar disc herniation; Nerves; Patients; Pediculectomy; Postoperative; Postoperative Complications - surgery; Retrospective Studies; Segments; Surgery; Transforaminal endoscopic lumbar discectomy; Treatment Outcome; Vertebrae
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-024-02379-2

The surgical resection of very highly migrated lumbar disc herniation (VHM-LDH) is technically challenging owing to the absence of technical guidelines. Hence, in the present study, we introduced the transforaminal endoscopic lumbar discectomy (TELD) with two-segment foraminoplasty to manage VHM-LDH and evaluated its radiographic and midterm clinical outcomes. The present study is a retrospective analysis of 33 consecutive patients with VHM-LDH who underwent TELD with two-segment foraminoplasty. The foraminoplasty was performed on two adjacent vertebrae on the basis of the migration direction of disc fragments to fully expose the disc fragments and completely decompress the impinged nerve root. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. Additionally, imageological observations were evaluated immediately after the procedure via magnetic resonance image and computerized tomography. Clinical outcomes were evaluated by calculating the visual analog scale (VAS) score and Oswestry Disability Index (ODI). The MacNab criterion was reviewed to assess the patients' opinions on treatment satisfaction. The resection rate of bony structures were quantitatively evaluated on postoperative image. The segmental stability was radiologically evaluated at least a year after the surgery. Additionally, surgery-related and postoperative complications were evaluated. The average age of the patients was 56.87 ± 7.77 years, with a mean follow-up of 20.95 ± 2.09 months. The pain was relieved in all patients immediately after the surgery. The VAS score and ODI decreased significantly at each postoperative follow-up compared with those observed before the surgery (P