Abstract
Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical
treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy
technique is a minimally invasive alternative with potential advantages such as minimal
blood loss and tissue damage, as well as early mobilization of the patient. We report
the implementation of this technique in a German university hospital setting.
Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February
2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as
perioperative, clinical, and radiologic data were analyzed from electronic records.
Furthermore, we investigated complications, intraoperative change of the procedure
to microsurgery, and reoperations. The postoperative course was analyzed using the
Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative
magnetic resonance imaging volumetric analyses were performed to assess the radiologic
efficacy of the technique.
Results Our study population had a median age of 52 years. The median follow-up was 15 months,
and the median length of hospital stay was 4 days. Median duration of surgery was
100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed
at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients,
surgery was performed for recurrent disk herniations. The procedure had to be changed
to conventional microsurgery in four patients. We observed no major complications.
Minor complications occurred in six patients, and in four patients a reoperation was
performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative
examination. In MRI volumetry, we detected a median postoperative volume reduction
of the disk herniation of 57.1% (p = 0.02).
Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university
hospital setting in selected patients with primary and recurrent lumbar disk herniations,
and it leads to good clinical and radiologic results. However, learning curve, caseload,
and residents' microsurgical training requirements clearly affect the implementation
process.
Keywords
transforaminal endoscopic surgery - lumbar disk herniation - learning curve - university
hospital setting
