Speculum lumbar extraforaminal microdiscectomy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Minimally Invasive Procedures

Background:

• Increasing emphasis on minimalism in lumbar disc excision due to public interest, cost, and diagnostic advancements.
• Current techniques like microlumbar discectomy and minimally invasive spinal surgery have limitations such as pain, hospital stay, and skill acquisition difficulty.
• Development of a novel, less invasive microscopic technique for outpatient lumbar disc excision with easily acquired skills.

Purpose of the Study:

• To describe a variant of minimally invasive lumbar disc excision.
• To assess the clinical effects of this technique on a small patient cohort.

Main Methods:

• Prospective community hospital-based case study evaluating a less invasive herniated lumbar disc excision method.
• Inclusion of 50 adult patients with intractable low back and leg pain due to lumbar disc herniations (L2-L5), excluding L5-S1 canal herniations.
• Surgical approach utilized a microscopic speculum transforaminal route for discs within or outside the spinal canal, with outcomes measured by return to work, MacNab criteria, and Prolo economic/functional criteria.

Main Results:

• Successful outpatient technical operations in all 50 initial patients using the less invasive technique.
• 84% of patients achieved excellent or good results (MacNab criteria), with a mean return to work time of 3.5 weeks.
• Significant improvements in economic and functional status reported post-surgery, with 80% requiring no pain medication one week after the procedure. One minor nerve root injury complication was noted.

Conclusions:

• A minimally invasive microscopic technique for lumbar disc excision is described, applicable to most herniated disc types except L5-S1 canal herniations.
• Clinical outcomes achieved with this technique are comparable to those of other discectomy methods.
• The described technique offers a viable, less invasive option for outpatient lumbar disc surgery.