1. 2018;21;E113-E123Transforaminal Endoscopic Discectomy for Treatment of Central Disc Herniation: Surgical Techniques and Clinical Outcome
   Retrospective Review
   Wenyuan Ding, MD, Jiaxin Xu, MD, Lichao Lian, MD, Wei Zhang, MD, and Yapeng Wang, MD.

BACKGROUND: Though transforaminal endoscopic discectomy has achieved a satisfactory clinical outcome in the treatment of paracentral disc herniation, it has a high failure rate for treating central disc herniation.

OBJECTIVE: To explore the surgical techniques of transforaminal endoscopic discectomy in treating central disc herniation and the clinical outcome based on 2-year follow-up.

STUDY DESIGN: A retrospective study.

SETTING: The Department of Spinal Surgery at the Third Hospital of Hebei Medical University in China.

METHODS: Sixty-nine consecutive patients (male:female = 14:9, mean age 38.8 ± 10.5 years) were enrolled in the study, all of whom underwent transforaminal endoscopic discectomy due to central disc herniation. The rod adjustment technique, apex technique, and posterior longitudinal ligament detection technique were adopted for intraoperative individualization. All of the patients were followed up for 24 months to assess the visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores. The postoperative segmental instability and recurrence were observed during the follow-up period as well. MacNab criteria scores were recorded both intraoperatively and at the final follow-up; postoperative complications and the surgical outcome and safety were also evaluated.

RESULTS: The herniated disc tissues were successfully removed for all patients, without revision by open surgery. Twenty-one cases (30.43%) were rated excellent, 44 (63.77%) good, 4 (5.80%) fair, and 0 (0.00%) poor upon the final follow-up, with an overall excellent-to-good rate of 86.96%. The VAS scores of low back and leg pain were all significantly lower at 3, 6, 12, and 24 months postoperatively compared to preoperatively (all P < 0.05). The JOA scores at the 3-month and 24-month postoperative follow-ups were significantly higher than the preoperative values (all P < 0.05). The ODI evaluation was significantly lower at 3 and 24 months postoperatively than preoperatively (all P < 0.05).

LIMITATIONS: The retrospective nature of this study is a limitation, as well as the small sample size and short observation time.

CONCLUSION: The application of novel surgical techniques can help improve the safety and efficacy of transforaminal endoscopic discectomy in treating central disc herniations. Intraoperative individualized application of rod adjustment technique, apex technique, or posterior longitudinal ligament detection technique is the key to satisfactory clinical outcome.

KEY WORDS: Central disc herniation, rod adjustment technique, transforaminal endoscopy, minimal invasion, complication