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Full-Endoscopic Interlaminar and Transforaminal Lumbar Discectomy Versus Conventional Microsurgical Technique: A Prospective, Randomized, Controlled Study

Ruetten, Sebastian, MD, PhD*; Komp, Martin, MD, PhD*; Merk, Harry, MD; Godolias, Georgios, MD

doi: 10.1097/BRS.0b013e31816c8af7
Randomized Trial

Study Design. Prospective, randomized, controlled study of patients with lumbar disc herniations, operated either in a full-endoscopic or microsurgical technique.

Objective. Comparison of results of lumbar discectomies in full-endoscopic interlaminar and transforaminal technique with the conventional microsurgical technique.

Summary of Background Data. Even with good results, conventional disc operations may result in subsequent damage due to trauma. Endoscopic techniques have become the standard in many areas because of the advantages they offer intraoperatively and after surgery. With the transforaminal and interlaminar techniques, 2 full-endoscopic procedures are available for lumbar disc operations.

Methods. One hundred seventy-eight patients with full-endoscopic or microsurgical discectomy underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: VAS, German version North American Spine Society Instrument, Oswestry Low-Back Pain Disability Questionnaire.

Results. After surgery 82% of the patients no longer had leg pain, and 14% had occasional pain. The clinical results were the same in both groups. The recurrence rate was 6.2% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: back pain, rehabilitation, complications, and traumatization.

Conclusion. The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, lumbar disc herniations outside and insidethe spinal canal can be sufficiently removed using the full-endoscopic technique, when taking the appropriate criteria into account. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures.

The prospective, randomized, controlled study compares the results of lumbar discectomies in full-endoscopic and microsurgical techniques. The clinical results of both techniques were equal in 178 patients, with advantages in operation technique and reduced traumatization in the full-endoscopic procedure.

From the *Department of Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology, St. Anna-Hospital Herne, University of Witten/Herdecke, Herne, Germany; †Clinic for Orthopaedics and Orthopaedic Surgery, Ernst Moritz Arndt University Greifswald, Greifswald, Germany; and ‡Center for Orthopaedics and Traumatology, St. Anna-Hospital Herne, University of Witten/Herdecke, Herne, Germany.

Acknowledgment date: April 25, 2007. First revision date: August 25, 2007. Second revision date: December 2, 2007. Acceptance date: December 3, 2007.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Sebastian Ruetten, MD, PhD, Department of Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology, St. Anna-Hospital Herne, Hospitalstrasse 19, 44649 Herne, Germany; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.