Endoscopic Intralaminar Approach for the Treatment of Lumbar Disc Herniation.

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Endoscopic Intralaminar Approach for the Treatment of Lumbar Disc Herniation.

World Neurosurg. 2017 Apr 05;:

Authors: Oertel JM, Burkhardt BW

Abstract
BACKGROUND: Almost every surgical approach carries the risk to cause some degree of spinal instability, especially in case of excessive resection of the lamina and facet joint. This study describes the endoscopic intralaminar approach (ILA) for the treatment of cranially and caudally migrated lumbar disc herniation.
METHODS: Thirty-one patients who underwent endoscopic ILA for 26 caudally and 5 cranially migrated lumbar disc herniation were identified from a prospectively database. At final follow-up a personal examination and a standardized questionnaire was conducted including Oswestry Disability Index (ODI), functional outcome according to modified MacNab Criteria. Additionally particular reference was given to back-pain, leg-pain and repeat procedure.
RESULTS: The mean final follow-up was 37.0 month (range 5-57 month) at which 29 patients attended (93.5%). No leg pain was noted in 95.0%, no back pain in 85.0%, full motor strength in 95.0%, and no sensory deficit in 95.0% of patients with ILA. Clinical success was reported by 95.0% of patients and the mean ODI was 9% in patients with ILA. Ten patients had an enlargement of ILA to conventional laminotomy (32.3%). By comparison of clinical outcome and repeat procedure rate in patients with ILA to patients with enlargement to laminotomy no significant differences were identified except for higher ODI (i.e.16%) in patients with enlargement of ILA.
CONCLUSION: Endoscopic ILA is a safe technique for the treatment of cranially and caudally migrated lumbar disc herniations. Careful procedure planning is recommended to protection of soft tissue and osseous structures and to achieve excellent clinical outcome.

PMID: 28391024 [PubMed - as supplied by publisher]

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