Advantages of Endoscopic Transforaminal Discectomy for Repeat Disc RemovalThe author of this article (Dr. T. Hoogland) has been involved for many years in performing lumbar discectomies (disc removal). The surgical technique has improved over the last two decades. Fifteen years ago, Dr. Hoogland developed new surgical tools to enhance the procedure. Special reamers are now available to make more room for an endoscope and other surgical instruments.
In this study, these special tools were used in patients with recurrent disc herniations. This is the first attempt to use transforaminal endoscopic discectomy for patients who needed another discectomy at the same level as the first operation.
The advantage of this technique is that it allows the surgeon to enter the spinal canal from the side and thereby avoid going through old scar tissue. By entering through the foramen (opening in the vertebral bone for the nerve root), the area could be widened at the same time.
This approach creates a working tunnel to the herniated disc. It also takes pressure off the nerve root and gives it more space. Local, rather than general, anesthesia was used (a second advantage). A third advantage is that less scar tissue is formed compared with dorsal techniques (going through the back of the vertebra to get to the disc material).
Decreased pain level, patient satisfaction, and rate of revision after a lumbar discectomy were the main outcome measures for this study. Early recurrence (within three months of the operation) was viewed as a postoperative complication.
Results were positive with a low complication rate and high patient satisfaction. Eighty-five per cent (85%) of the patients gave the surgery results a good to excellent rating. There was improvement in back and leg pain. Recurrence rate was less than five per cent.
Dr. Hoogland concludes that endoscopic transforaminal discectomy can be used effectively for repeat discectomies. There are many advantages to this technique over microdiscectomy. Being able to reach the protruding disc material without interference from scar tissue is an important breakthrough in surgical technique.
Thomas Hoogland, MD, PhD, et al. Endoscopic Transforaminal Discectomy for Recurrent Lumbar Disc Herniation. In Spine. April 20, 2008. Vol. 33. No. 9. Pp. 973-978.
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