Extreme Lateral Endoscopic Transforaminal Lumbar Discectomy for Lumbar Disc Herniation in Young Patients

Objective: The herniated lumbar disc (HLD) in young patients is increasing. The endoscopic discectomy has been used as a treatment option, but it is limited in the management of large extruded or migrated disc herniations. Recently, with an application of extreme lateral endoscopic lumbar discectomy (ELELD), it is possible to obtain access to epidural space directly and to remove herniated disc. In this study, result of ELELD based on the direction of disc protrusion, degree of protrusion and migration of the protrude disc in young patients were assessed. Methods: Retrospective study of 135 patients with HLD underwent ELELD was conducted. The patients were classified according to size, type and degree of disc herniation. Axial locations of those herniations were divided central, posterolateral and foraminal. Migrated herniations were classified into low or high grade according to the extent of migration. Results: The average visual analogue scale (VAS) pain score was reduced from 8.92±1.20 to 2.38±1.55 (p<0.05). Highgrade migration group showed lower success rate compared with other group. The failures were considered to result from a free fragment having migrated too far from disc level in the lateral recess to be effectively removed. The patient with the poor result underwent open surgery subsequently. Conclusion: The ELELD has expanded capabilities of previous endoscopic procedures including posterolateral approach and can be surgical alternative to conventional microdiscectomy. However, open surgery is more advisable rather than endoscopic discectomy in the lumbar disc herniation with high-grade migration.