Transforaminal Endoscopic Discectomy For Treatment Of Central Disc Herniation:Surgical Techniques And Clinical Outcome

Objective: Though transforaminal endoscopic discectomy has achieved a satisfactory clinical outcome in the treatment of paracentral disc herniation,it has a high failure rate for treating central disc herniation.The aim of the study is to explore the surgical techniques of transforaminal endoscopic discectomy in treating central disc herniation and the clinical outcome based on 2-year follow-up.Methods: Sixty-nine consecutive patients(male: female = 14: 9,mean age 38.8 ± 10.5 years)were enrolled in the study,all of whom underwent transforaminal endoscopic discectomy due to central disc herniation."Rod adjustment technique","apex technique" and "posterior longitudinal ligament detection technique" were adopted for intraoperative individualization.All patients were followed up for 24 months to assess the visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI).The postoperative segmental instability and recurrence were observed during the follow-up period.The patients' final follow-up MacNab scores were recorded,as well as intraoperative,postoperative complications,and the surgical outcome and safety were evaluated.Results: The herniated disc tissues were successfully removed for all patients,without revision by open surgery.Twenty-two cases [31.88%] were rated excellent,44 [63.77%] good,3 [4.35%]fair,and 0 [0.00%]poor upon the final follow-up,with an overall excellent-to-good rate of 95.65%.The VAS scores of low back and leg pains were all significantly lower at 3,6,12 and 24 months postoperatively than preoperatively(all P <0.05).JOA scores at 3-and24-month postoperative follow-ups were significantly higher than preoperative values(all P <0.05).The ODI index was significantly lower at 3 and 24 months postoperatively than preoperatively(all P <0.05).Conclusions: The application of novel surgical techniques can help improve the safety and efficacy of transforaminal endoscopic discectomy in treating the central disc herniation.Intraoperative individualized application of "rod adjustment technique","apex technique" and "posterior longitudinal ligament detection technique" is the key to the satisfactory clinical outcome.