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Full-Endoscopic Visualized Foraminoplasty and Discectomy Under General Anesthesia in the Treatment of L4-L5 and L5-S1 Disc Herniation

Hua, Wenbin MD; Zhang, Yukun MD; Wu, Xinghuo MD; Gao, Yong MD; Li, Shuai MD; Wang, Kun MD; Yang, Shuhua MD; Yang, Cao MD

doi: 10.1097/BRS.0000000000003014
SURGERY
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Study Design. Retrospective analysis of clinical records.

Objective. The aim of this study is to evaluate the clinical outcomes and neurological complications of full-endoscopic visualized foraminoplasty and discectomy under general anesthesia for the treatment of L4-L5 and L5-S1 disc herniation.

Summary of Background Data. Full-endoscopic visualized foraminoplasty and discectomy, which is our newly developed technique, has been used in the treatment of lumbar disc herniation and lumbar spinal stenosis. While the clinical effect, safety, and neurological complications of full-endoscopic visualized foraminoplasty and discectomy under general anesthesia are still uncertain.

Methods. Between May 2015 and April 2017, 84 patients with lumbar disc herniation were included, and categorized into L4-L5 group and L5-S1 group according to the discectomy segment. Full-endoscopic visualized foraminoplasty and discectomy was performed under general anesthesia. Operative time, fluoroscopy time, hospitalization time, and complications were recorded. Each patient included was followed for at least 12 months. Visual analog scale score for leg and back pain and Oswestry Disability Index score were evaluated preoperatively and at 3, 6, and 12 months postoperatively. The modified MacNab criteria were also used to evaluate surgical effectiveness.

Results. The mean operative time, fluoroscopy time, and hospitalization time at L4-L5 and L5-S1 were of no significant difference. The mean visual analog scale and Oswestry Disability Index postoperative scores were significantly improved over the preoperative scores. Intraoperative nerve injury occurred in one case at L4-L5, with a neurological complication rate of 2.1% in L4-L5 group. One case at L4-L5 suffered recurrence 2 weeks after the surgery, resulting in a recurrence rate of 2.1% in L4-L5 group. This recurrence case was treated by a second full-endoscopic visualized foraminoplasty and discectomy under general anesthesia.

Conclusion. Full-endoscopic visualized foraminoplasty and discectomy under general anesthesia is efficient and safe for the treatment of L4-L5 and L5-S1 disc herniation.

Level of Evidence: 4

Full-endoscopic visualized foraminoplasty and discectomy, which is a newly developed technique from traditional transforaminal endoscopic spine system technique, can be performed under excellent endoscopic visualization. It is efficient and safe to treat L4-L5 and L5-S1 disc herniation, with significant improvement of the pain scores and low complication rate.

Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Address correspondence and reprint requests to Cao Yang, MD, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; E-mail: yangcao1971@sina.com

Received 17 September, 2018

Revised 31 January, 2019

Accepted 11 February, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

National Key Research and Development Program of China (2018YFB1105700) and the National Natural Science Foundation of China (Grant nos. 81772401 and U1603121) funds were received in support of this work.

No relevant financial activities outside the submitted work.

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