Transforaminal Unilateral Biportal Endoscopic Spinal Surgery for Extraforaminal Lumbar Disc Herniation: A Retrospective Observational Study

Chih-Ying Wu; Hsiang-Ming Huang; Han-Chung Lee; Chih-Hsin Tang; Yung-Hsiang Chen; Cheng-Di Chiu

doi:10.1016/j.wneu.2023.12.162

Transforaminal Unilateral Biportal Endoscopic Spinal Surgery for Extraforaminal Lumbar Disc Herniation: A Retrospective Observational Study

World Neurosurg. 2024 Mar:183:e658-e667. doi: 10.1016/j.wneu.2023.12.162. Epub 2024 Jan 3.

Authors

Chih-Ying Wu¹, Hsiang-Ming Huang², Han-Chung Lee³, Chih-Hsin Tang⁴, Yung-Hsiang Chen⁵, Cheng-Di Chiu⁶

Affiliations

¹ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
² Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan.
³ Neuroscience Center, Everan Hospital, Taichung, Taiwan.
⁴ Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taichung, Taiwan; Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Health Science, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
⁵ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
⁶ Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taichung, Taiwan; Spine Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan. Electronic address: cdchiu4046@gmail.com.

PMID: 38181875
DOI: 10.1016/j.wneu.2023.12.162

Abstract

Objective: Biportal endoscopic spinal surgery (BESS) is recommended as a safer and less destructive option for lumbar disc herniations. However, limited data exist on clinical outcomes for extraforaminal lumbar disc herniation (ELDH) surgery. This retrospective study presents our preliminary experience with transforaminal unilateral BESS for ELDH.

Methods: Patients with lumbar radiculopathy refractory to conservative treatment, diagnosed with ELDH by magnetic resonance imaging, and treated with transforaminal unilateral BESS in 2021-2023 in 2 institutions in Taiwan were eligible for inclusion. Those with lumbar spondylolisthesis grade 2 or more with segmental instability, history of drug abuse or psychiatric diseases, or with a follow-up duration <1 year were excluded. Primary outcomes included visual analog scale for pain, assessed at 1 week, 1 month, 6 months, and 1 year using generalized estimating equations analysis; success and satisfaction of BESS graded by the Macnab criteria; and perioperative complications. Secondary outcomes were operative time and hospital length of stay.

Results: Seventeen patients were included in the analysis, with a mean age of 65.8 years; 11 (64.7%) were males and 15 (88.2%) had no prior lumbar spine surgery. mean operative time was 107.9 minutes, and length of stay was 3.5 days. Graded by Macnab criteria, 16 (94.1%) of patients had good to excellent outcomes. Only 1 patient experienced complications. No recurrence/reoperation was observed. Generalized estimating equations analysis showed that postoperative visual analog scale scores decreased significantly at 1 week (adjusted Beta [aBeta] = -5.47, standard error: 0.29, P < 0.001), 1 month (aBeta = -5.82), 6 months (aBeta = -5.88), and 1 year (aBeta = -6.29).

Conclusions: Transforaminal unilateral BESS is an alternative and feasible method for treating ELDH, producing good surgical outcomes with few complications and sustaining pain improvement. Future studies with larger patient numbers and comparisons between BESS and other minimally invasive techniques for ELDH are warranted.

Keywords: Extraforaminal lumbar disc herniation (ELDH); Transforaminal approach; Unilateral biportal endoscopic spinal surgery (BESS).

Publication types

Observational Study

MeSH terms

Aged
Diskectomy, Percutaneous* / methods
Endoscopy / methods
Female
Humans
Intervertebral Disc Displacement* / diagnostic imaging
Intervertebral Disc Displacement* / surgery
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / surgery
Male
Pain / surgery
Retrospective Studies
Treatment Outcome