Outpatient, awake, ultra-minimally invasive endoscopic treatment of lumbar disc herniations.

BACKGROUND Endoscopic discectomy is an ultra- minimally invasive outpatient surgical option for the treatment of lumbar herniated discs. The purpose of this study was to assess the benefit of tranforaminal versus interlaminar endoscopic discectomy in patients with single level Lumbar 5-Sacral 1(L5-S1) disc herniations and lumbar radiculopathy. METHODS After Institutional Review Board Approval, charts from 41 consecutive patients with complaints of lower back and radicular pain and an L5-S1 herniated disc who underwent an endoscopic procedure between 2007 and 2012 were reviewed. The transforaminal approach was used for patients with far lateral, foraminal, and paracentral disc herniations and the intralaminar approach was used for herniations that were more central. RESULTS The average pain relief 1-year postoperatively was 75.9% for the transforaminal group and 75.3% for the interlaminar group, both excellent results as defined by MacNab. The average preoperative visual analogue scale (VAS) scores were 8.2 and 8.4 for the transforaminal and interlaminar groups respectively, indicated in our questionnaire as severe and constant pain. The average 1-year postoperative VAS scores were 1.7 and 2.1, indicated in our questionnaire as mild and intermittent pain. There were no complications in the series of patients treated. CONCLUSIONS The 1-year follow-up data presented here for transforaminal and intralaminar approaches to L5-S1 disc herniations appears to indicate that either approach can be used as determined to best suit the pathology without sacrificing the probability of postoperative pain improvement.