fragmentectomies without bone removal – long term follow-up.

EANS Sept. 2019 Dublin, Ireland

Background:

This study tracked and analyzed the long-term effects of endoscopic discectomy on 34 patients at L5-S1 and L4-5 using a paramedian approach to extract free fragments in the spinal canal. Using only local anesthetic and IV sedation, these procedures involved the passing of an endoscope, grasper, and a straight cannula with approximately 4 mm diameter into the spinal canal through the interlaminar space without any bone or joint removal, and by only spreading the muscle and ligamentum flavum fibers. The pathology was removed without any bleeding, retraction, or dissection which commonly leads to scarring in invasive discectomy procedures.

Methods:
Follow-up from 34 patients composed of 12 females and 22 males was conducted at an average 4.73 years after procedure, with an average age of 43.52 years. The patients were evaluated on the Oswestry Low Back Pain Questionnaire prior to surgery and during the final follow-up.

None of the patients in the group was at the ambulatory surgery center for longer than an hour post-operatively. 97.06 % of the patients returned to work within a week. None of the patients had previous lumbar spine surgery, or a subsequent surgery.

Results:
The average patient preoperative ODI was 58.41. The average patient ODI at last follow up was 2.63, with MacNab criteria showing 6 G (good) and 28 E (excellent).

Conclusions:
The above results demonstrate that the presented approach provides a considerable reduction in patient ODI in long-term follow up. Furthermore, this approach does not cause trauma typically seen in more invasive spine discectomies. Consequently, the presented approach is superior to more invasive approaches in providing better results and faster post-procedure recovery in patients with fragments in the spinal canal at L5-S1 and at L4-5.