Extra-foraminal microscopic assisted percutaneous nucleotomy for foraminal and extraforaminal lumbar disc herniations

Publication date: Available online 4 September 2017
Source:The Spine Journal
Author(s): Ahmed Shawky, Dusko Babic, Ahmed Ezzat Siam, Ali Ezzati
BackgroundForaminal and extraforaminal lumbar disc herniations are uncommon. The main presentation is radicular pain related to the exiting nerve root at the affected level. Different approaches for surgical intervention have been described.PurposeTo evaluate the clinical outcome, complications recurrence and reoperation rate of extraforaminal microscopic assisted percutaneous nucleotomy with literature review focusing on complications and recurrence rateStudy DesignProspective cohort study done in a high flow spine center in GermanyPatient SampleBetween October 2012 and October 2015, 76 patients (35 females and 41 males) with foraminal or extraforaminal lumbar disc prolapse were operated upon.Outcome Measures• Self-report measures: Visual Analogue Scale (VAS) for leg pain and back pain.• Physiologic measures: standing plain x-rays (antero-posterior, lateral, and dynamic views)• Functional measures: Oswestry Disability Index (ODI) (validated German version) and Odom's criteriaMethodsAll patients were operated upon with Trans-tubular Extraforaminal Microscopic-assisted Percutaneous (EF-MAPN) technique. Preoperative clinical and neurological evaluation were done. The mean follow up period was 38 months (range 12 - 54). The study hasn't received funding for research from any organisation. All authors do not have any conflict of interest.ResultsThe mean age was 54 years. The most commonly affected level was L4/5 (34 patients). The mean preoperative VAS for leg pain was 7.6 (3-10), improved to 1.4 (0-4) postoperatively. The average operative time was 57.5 minutes. There were no intraoperative complications. One patient had temporary postoperative quadriceps weakness (L4 radiculopathy) that was completely improved at 3 months follow up. Another patient had deep venous thrombosis after discharge. Two patients had recurrences that necessitated another operation within the first 6 months postoperatively. Both were followed up for one year without a second recurrence.ConclusionTrans-tubular percutaneous extra-foraminal microscopic-assisted nucleotomy is effective for foraminal and extra-foraminal disc herniations. It is a muscle splitting minimal-invasive approach with minimal morbidity. Complications, recurrence and reoperation rate is not different compared with microsurgical open or endoscopic techniques.



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