Transforaminal Endoscopic Discectomy Under General and Local Anesthesia: A Single-Center Study

Area of Science:

• Neurosurgery
• Anesthesiology
• Spinal Surgery

Background:

• Percutaneous spinal endoscopy is an alternative to traditional surgery for lumbar spine disorders.
• Anesthesia is essential for percutaneous spinal endoscopy, with local anesthesia (LA) and general anesthesia (GA) being the primary methods.
• Existing literature on the comparative benefits of LA versus GA for this procedure is inconclusive.

Purpose of the Study:

• To compare the efficacy and safety of local anesthesia (LA) versus general anesthesia (GA) for percutaneous spinal endoscopy.
• To evaluate postoperative complications and patient outcomes associated with each anesthesia type.

Main Methods:

• A prospective case-control study involving 40 patients undergoing percutaneous spinal endoscopy.
• Patients were divided into two groups: 20 receiving LA and 20 receiving GA.
• Outcomes assessed included intraoperative pain, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and postoperative complications.

Main Results:

• The LA group reported intraoperative pain in 45% of patients (40% moderate, 5% excruciating).
• While VAS and ODI scores improved faster in the LA group, no significant 12-month difference was observed between groups.
• The GA group experienced postoperative complications including nerve root injury (10%), nausea, vomiting, dizziness, and drowsiness (15%), which were minimal or absent in the LA group.

Conclusions:

• Local anesthesia (LA) demonstrates superior short-term outcomes for percutaneous spinal endoscopy, particularly in preventing nerve root damage.
• LA is associated with fewer postoperative side effects, enhancing patient well-being in the immediate recovery period.
• While long-term functional outcomes may be similar, LA offers distinct advantages for immediate post-procedural recovery in spinal endoscopy.