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Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm.

Vit Kotheeranurak^1,2, Wongthawat Liawrungrueang³, Javier Quillo-Olvera⁴

¹Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

|February 6, 2023

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Summary

This study proposes a new algorithm to guide surgeons in choosing between transforaminal endoscopic lumbar discectomy (TELD) and interlaminar endoscopic lumbar discectomy (IELD) for lumbar disc herniation (LDH). The algorithm optimizes surgical approach selection based on herniation location and patient anatomy.

Area of Science:

Neurosurgery
Minimally Invasive Spine Surgery
Spinal Diagnostics

Background:

Full-endoscopic discectomy is increasingly utilized for lumbar disc herniation (LDH).
A standardized algorithm for selecting the optimal endoscopic approach (TELD vs. IELD) has been lacking.
This study addresses the need for evidence-based guidance in endoscopic spine surgery.

Approach:

A systematic literature review adhering to PRISMA guidelines was conducted.
Data from 53 selected articles on full-endoscopic discectomy for LDH were analyzed.
Key opinion leaders provided expert input to refine the decision-making algorithm.

Key Points:

The algorithm stratifies TELD (transforaminal endoscopic lumbar discectomy) for foraminal/extraforaminal LDH and central/subarticular discs at upper levels.

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IELD (interlaminar endoscopic lumbar discectomy) is recommended for central/subarticular LDH at L4/L5 and L5/S1, particularly with anatomical variations.

The algorithm considers herniation zone, level, and specific patient anatomical features.

Conclusions:

The developed algorithm provides a structured approach for selecting TELD or IELD in full-endoscopic lumbar discectomy.
This tool aims to enhance surgical decision-making and optimize patient outcomes for LDH treatment.
The algorithm integrates anatomical considerations with pathology location for tailored surgical planning.