Full-Endoscopic Lumbar Discectomy Approach Selection

Abstract

Study Design. A systematic review of the literature to develop an algorithm formulated by key opinion leaders.Objective. This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. Summary of Background Data. Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. Materials and Methods. A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). Results. In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. Conclusions. The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.

Commentary on “The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries”

“…With improved patient outcomes and cost-effectiveness, these techniques are likely to become more acceptable, relevant, and popular in the coming years. 9,13,[15][16][17][18] In conclusion, we agree with the authors regarding the inherent limitations of retrospective study and the potential for bias-es. Including patients who underwent open surgery or other minimally invasive techniques would strengthen the illustration of the efficacy of the endoscopic surgery technique.…”

Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years

“…Long-term follow-up is essential for a comprehensive evaluation of the outcomes associated with TELD, a relatively recent surgical technique. To accurately assess the application value of TELD, it is crucial to carefully select patients suitable for TELD and establish an appropriate control group [ 24 , 25 ]. We thoroughly assessed all patients in the present study, excluding those unsuitable for the transforaminal approach because of severe prolapse, a high iliac crest, and other conditions.…”

“…The exclusion criteria were (1) severe migration of an intervertebral disc (zones 1 and 4 according to the classification established by Lee et al [ 22 ]) ( Supplementary Fig. 1 ); (2) a high iliac crest (above the mid-L5 pedicle on lateral radiography) [ 23 ]; (3) severe calcification, bilateral symptoms, or other conditions that could be treated by MD but were unsuitable for TELD according to the surgeon’s experience [ 24 ]; (4) evidence of severe central lumbar spinal stenosis, segmental instability, infection, fractures, or tumors; (5) diseases involving other systems, such as cerebrovascular disease, that could potentially impact the clinical evaluation; and (6) a history of lumbar surgery [ 20 , 25 ]. A detailed flowchart is presented in Supplementary Fig.…”

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

“…Lumbar disc herniation (LDH) is a common spinal disorder that usually results in pain and dysfunction [ 1 ]. Among the various surgical approaches available, full endoscopic transforaminal discectomy (FETD) has gained popularity as a minimally invasive technique that offers potential advantages such as reduced tissue trauma and faster recovery [ 2 , 3 ].…”