Endoscopic Microdiscectomy is an Effective Treatment Option for Far-Lateral Lumbar Disc Herniations

Introduction: Far lateral lumbar disc herniations (FLLDH) pose a surgical challenge given the difficulty in visualizing the pathology with traditional techniques. Endoscopic microdiscectomy is a novel technique for the treatment of FLLDHs with decreased soft tissue disruption. The objective of this study was to compare the efficacy of tubular vs. endoscopic microdiscectomy for FLLDH.

Methods: Patients undergoing endoscopic or tubular decompression for FLLDH over a five-year period were included. The primary outcome was patient-reported outcome measures (PROMs). Secondary outcomes included operative time, intra-operative radiation, length of stay (LOS), and reoperation/complication rates. Comparisons between non-paired continuous variables were done with a two-tailed independent sample t-test. Categorical variables were compared with a chi-squared or a Fisher exact test. Significance was assumed at p< 0.05.

Results: 135 patients were identified with 64 having undergone endoscopic and 71 tubular microdiscectomy. There were no differences in operative times (67.7-vs.-68.2min, p=0.93) or LOS (945.5-vs.-911.1min, p=0.79). Endoscopic microdiscectomy was associated with increased total fluoroscopy time (105.92-vs.34.66s, p< 0.001) and intraoperative radiation dose (33.68-vs.-19.12mGy, p< 0.001). Post-operatively both groups had statistically significant decreases in all PROM metrics at early and late follow-up. There was no difference in the magnitude of improvement or the rate of postoperative complications/reoperations between the groups.

Conclusion : Endoscopic microdiscectomy is an effective technique for the treatment of FLLDH, with significant improvement in all PROMs post-operatively and no differences in clinical outcomes. Endoscopic microdiscectomy is associated with increased intra-operative radiation exposure, however.