Contralateral Translaminar Endoscopic Approach for Highly Down-migrated Lumbar Disc Herniation using Percutaneous Biportal Endoscopic Surgery

Abstract

Objective: Unilateral biportal endoscopy （UBE）is a minimally invasive spine surgery with reduced traumatization of the posterior lumbar ligament and muscular structures. This study reports contralateral translaminar approach with UBE for highly down-migrated lumbar disc herniation (LDH). Methods: Data of 32 patients with highly down-migrated LDH treated using UBE at Hangzhou TCM hospital from January 2020 to July 2022 were retrospectively analyzed. The operation time and perioperative complications were recorded, and the visual analog scale (VAS) of pain was recorded to evaluate the degree of lower back and extremity pain. The Oswestry disability index (ODI) was used to evaluate lumbar spine function. The modified MacNab score was used to evaluate clinical efficacy. Results: All patients successfully underwent the operation, with a time range from 47 to 65 minutes and an average operation time of 56.09 ±5.11 minutes. Overall, 17 and 15 were males and females, respectively, with ages ranging from 34 to 72 years and an average age of 56 ±7.89 years. The postoperative follow-up period was 12–18 months, with an average of 14.9 ±2.3 months. The postoperative lower back VAS pain score and ODI were statistically significant compared with preoperatively (P < 0.05). At the final follow-up, according to the modified Macnab criteria, 90.6% of cases were classified as good or excellent. Conclusion: UBE treatment of highly down-migrated LDH through the contralateral translaminar approach is safe and efficient. Therefore, this approach can be an efficient alternative for patients with highly downward-migrating LDH.