Kapetanakis Stylianos, Gkantsinikoudis Nikolaos
1Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki; and.
2Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece.
J Neurosurg Spine. 2024 Oct 25;42(1):49-55. doi: 10.3171/2024.7.SPINE24389. Print 2025 Jan 1.
Extraforaminal lumbar disc herniation (ELDH) represents a unique clinical entity, presenting particular challenges in surgical management. Transforaminal lumbar endoscopic discectomy (TLED) represents a minimally invasive, full-endoscopic procedure that is increasingly selected for surgical treatment of lumbar disc herniation, being theoretically ideal in patients with ELDH. Performance of TLED for management of ELDH has been reported in specific studies in the recent literature. However, foraminal anatomy is significantly disrupted in cases of ELDH, a fact that may represent a true challenge for the operating surgeon, in terms of proper endoscopic visualization. Hence, the aim of this study was to investigate midterm clinical outcomes of a unique modification of the TLED technique in patients with ELDH, in an attempt to enhance endoscopic visualization of foraminal structures and to facilitate safe and effective decompression in these cases.
Twenty-five patients with ELDH were enrolled in this study. All patients underwent modified TLED (mTLED) in the authors' center and were retrospectively assessed. Clinical evaluation was performed via the visual analog scale at 6 weeks; at 3, 6, and 12 months; and at 2 and 5 years postoperatively on an outpatient basis. Moreover, the functional status of enrolled individuals was evaluated with modified Macnab criteria at the end of follow-up.
All patients underwent successful mTLED; the mean operative time was 23.7 ± 3.4 minutes. All patients were discharged on the same day as their operation, exhibiting no major perioperative complications. Three patients (12%) reported transient postoperative dysesthesia, which was completely resolved 6 weeks postoperatively. Recorded visual analog scale values were significantly ameliorated up to the end of follow-up, featuring maximal improvement at 6 weeks, with subsequent minimal amelioration and stabilization. According to modified Macnab criteria, excellent or good outcomes were observed in 23 patients (92%), whereas the outcome was fair in 2 patients (8%).
mTLED represents a feasible, safe, and effective alternative to conventional TLED and conventional open procedures for the management of ELDH. However, the precise role of this technical modification should be further investigated in future studies.
椎间孔外型腰椎间盘突出症（ELDH）是一种独特的临床病症，在手术治疗中存在特殊挑战。经椎间孔腰椎内镜下椎间盘切除术（TLED）是一种微创的全内镜手术，越来越多地被选用于腰椎间盘突出症的手术治疗，理论上对ELDH患者是理想的选择。近期文献中的特定研究报道了TLED用于治疗ELDH的情况。然而，在ELDH病例中，椎间孔解剖结构严重破坏，就内镜的正确可视化而言，这一事实可能对手术医生构成真正的挑战。因此，本研究的目的是调查一种独特改良的TLED技术在ELDH患者中的中期临床疗效，以增强椎间孔结构的内镜可视化，并在这些病例中促进安全有效的减压。
25例ELDH患者纳入本研究。所有患者均在作者所在中心接受改良TLED（mTLED）治疗，并进行回顾性评估。术后6周、3个月、6个月、12个月以及2年和5年门诊时通过视觉模拟量表进行临床评估。此外，在随访结束时用改良Macnab标准评估纳入个体的功能状态。
所有患者均成功接受mTLED；平均手术时间为23.7±3.4分钟。所有患者均在手术当天出院，未出现重大围手术期并发症。3例患者（12%）报告术后出现短暂感觉异常，术后6周完全缓解。记录的视觉模拟量表值在随访结束时显著改善，在6周时改善最大，随后改善最小并趋于稳定。根据改良Macnab标准，23例患者（92%）疗效为优或良，2例患者（8%）疗效为一般。
mTLED是治疗ELDH的一种可行、安全且有效的替代传统TLED和传统开放手术的方法。然而，这种技术改良的确切作用应在未来研究中进一步探讨。
