A Clinical Study on Functional Outcome of Percutaneous Transforaminal Endoscopic Discectomy under Local Anesthesia

Abstract

Background: Many surgical approaches from conventional open discectomy, microdiscectomy, percutaneous endoscopic interlaminar discectomy, and transforaminal endoscopic discectomy have been used for the treatment of prolapsed intervertebral disc. Transforaminal endoscopic discectomy through a Kambin’s triangle is a minimally invasive procedure which can be done under local anesthesia, without muscle splitting, with short hospital stay and minimal complications compared to other techniques used. Aim: The aim of this study was to evaluate the functional outcomes following percutaneous transforaminal endoscopic discectomy (PTED) under local anesthesia for lumbar disc herniations. Materials and Methods: This interventional study was conducted between November 2020 and October 2021 in our Orthopaedics Department after the clearance of the Ethical Committee. This study included 54 patients with radicular pain for at least 3 weeks with a positive nerve root compression sign and who underwent PTED under local anesthesia. The Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) have been used for pre- and postoperative clinical assessment of the patients, and follow-up was done at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results: Maximum patients were in the age group of 61–70 years, and 65.2% of the patients were male. 68.2% of patients had lumbar disc herniation at L4-L5 level. The mean operative time of PTED was 70.6 min. Out of 16 cases of L5-S1 disc prolapse, 1 case was operated by making an iliac bone window due to the inaccessibility of disc space because of highly placed iliac crest. The mean preoperative VAS and ODI scores were 8.1 and 56.6, respectively. The postoperative VAS and ODI scores were dramatically improved at each follow-up interval (P < 0.0001). Out of 66 patients who underwent operation, 4 patients developed surgical site infection and 2 were found to have dysesthesia, and no serious complications were noted. Conclusion: PTED has been shown to be a safe, effective, and minimally invasive alternative for the treatment of lumbar disc herniation. PTED found to be favorable because it had a shorter operational time and less epidural scarring, allowing for simple revision procedures as needed. As a result, this points to a greater acceptability of endoscopic procedures and their possible widespread use in the future.