Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence

Abstract

Endoscopic disc surgery (EDS) for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. Rate of recurrence/residual, complications, and outcomes, in comparison with standard microdiscectomy (MD), is still debated and need further data. We performed an extensive review based on the last 6 years of surgical series, systematic reviews, and meta-analyses reported in international, English-written literature. Articles regarding patients treated through endoscopic transforaminal or interlaminar approaches for microdiscectomy (MD) were included in the present review. Papers focused on endoscopic surgery for other spinal diseases were not included. From July 2009 to July 2015, we identified 51 surgical series, 5 systematic reviews, and one meta-analysis reported. In lumbar EDS, rate of complications, length of hospital staying, return to daily activities, and overall patients' satisfaction seem comparable to standard MD. Rate of recurrence/residual seems higher in EDS, although data are nonhomogeneous among different series. Surgical indication and experience of the performing surgeon are crucial factors affecting the outcome. There is growing but still weak evidence that lumbar EDS is a valid and safe alternative to standard open microdiscectomy. Statistically reliable data obtained from randomized controlled trials (better if multicentric) are desirable to further confirm these results.

The Value of a Synthetic Model-based Training Lab to Increase Proficiency with Endoscopic Approaches to the Spine

“…The learning curve associated with endoscopic approaches to the spine is a known challenge to more widespread adoption of these techniques [12,13,16,17]. Indeed, there have been several studies that show a steep decline in re-operations as the number of cases performed by the surgeon increases [2,3,12,18,19]. While the relatively rapid acquisition of proficiency in this technique is encouraging, it still poses a problem for the inexperienced practitioner.…”

“…There has been significant progress in the development of endoscopic techniques to treat spinal pathology over the past few decades [1]. While these surgeries were initially limited to decompressive procedures, endoscopic-assisted fusion surgeries are now gaining increasing popularity [2][3][4][5][6][7][8][9]. These approaches offer the same benefit as traditional open approaches with reduced blood loss, decreased postoperative pain, and earlier discharge [2,10,11].…”

A review of surgical techniques of lumbar disc herniation

“…Contraindications are as follows: skin inflammation in the operated area, cauda equina syndrome, large herniations, sequestration, clinically relevant instabilities and spine deformities, and motor deficit [9]. The procedure is performed under general or local anaesthesia with the use of a C-arm.…”

“…Indications include: intraforaminal herniations, lateral herniations, and nerve root canal stenosis. Contraindications include L5/S1 herniations -iliac crest is an obstacle for the needle, large median herniations [9,10]. This procedure can also be performed under local anaesthesia, which allows verbal contact to be maintained with the patient as well as direct monitoring of motor function.…”

“…Then the dural sac, nerve root, and the hernia need to be located, and the degenerated nucleus is removed. Indications include the following: median herniations, L5/S1 herniations, intervertebral foramen stenosis, and synovial cyst [7,9]. Possible complications include: dural tears, nerve root damage (2.8-17%), haematoma, vessel injury, and infection [10].…”