Initial clinical outcomes of percutaneous full-endoscopic lumbar discectomy using an interlaminar approach at the L4-L5

Background: percutaneous full-endoscopic discectomy (ped) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. ped using the interlaminar approach (ped-il) at l4-l5 is performed by only a few surgeons. to the best of our knowledge,the safety and efficacy of ped-il at l4-l5,without experience in ped via a transforaminal approach (ped-tf) has not been previously reported. objective: this study aimed to evaluate initial clinical outcomes and complications of ped-il at l4-l5 without experience in ped-tf. study design: retrospective evaluation. setting: an urban minimally invasive spine hospital. methods: of a total of 50 patients (36 men and 14 women,ages ranging from 21-59 years,with the average age being 40.3 years old),16 cases were performed at l4-l5 and 34 cases were performed at l5-s1. ped-il was successfully completed in all cases,and no case required conversion to open surgery. the operative time,hospital stay,modified macnab criteria,and visual analog scale (vas) scores were examined at l5-s1 (range: 41-112). there was no significant difference in operative time between the l4-l5 and l5-s1 groups; the operative time was gradually decreased. the mean hospital stay was 2.9 days (range: 2-8 days). according to modified macnab criteria,20 cases (6 at l4-l5 and 14 at l5-s1) were excellent,27 (10 at l4-l5 and 17 at l5-s1) were good,one at l5-s1 was fair,and 2 at l5-s1 were poor. two perineurium tears occurred at l5-s1. there was no infection or recurrence of herniated nucleus pulposus (hnp). the clinical outcomes of ped-il at l4-l5 were equal to those at l5- s1. results: the mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at l4-l5 (range: 52-102 mins.),and 70.5 ± 20.1 minutes at l5-s1 (range: 41-112 mins.). limitations: a small sample size and a short follow-up period. conclusions: the clinical outcomes of ped-il at l4-l5 were equal to those at l5-s1. therefore,ped-il is suitable to be a standard method for any type of intracanalicular disc herniation. © 2017,american society of interventional pain physicians. all rights reserved.