Beyond traditional surgery for far lateral lumbar herniation: transforaminal full endoscopic discectomy

This study aimed to evaluate the clinical outcomes of transforaminal full-endoscopic lumbar discectomy (FELD) for treating lateral lumbar disc herniation.

A retrospective single-center study was conducted at Centre Orthopédique Santy, Lyon, France, including 58 adult patients with foraminal or extraforaminal lumbar disc herniations who underwent surgery between October 2020 and January 2023. Inclusion criteria were patients with significant functional impairment due to unilateral radicular pain unresponsive to conservative treatment for over six weeks. Data on demographics, clinical characteristics, and outcomes were collected, evaluated preoperatively and at 12 months postoperatively using Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Macnab criteria.

The cohort had a mean age of 56.5 years and consisted predominantly of males, with 35 men (60%). Most herniations were at the L4-L5 level (29 patients, 50%). Significant improvements were observed in lumbar VAS (mean reduction of 1.9 points, p < 0.001), radicular VAS (mean reduction of 4.9 points, p < 0.001), and ODI (mean reduction of 41.9 points, p < 0.001) scores. Patient satisfaction was high, with 91% (53 patients) reporting excellent or good outcomes. The reoperation rate was 6.9% (4 patients). Linear regression analysis indicated that longer symptom duration and higher preoperative radicular VAS scores predicted greater satisfaction.

Transforaminal FELD is a safe and effective technique for treating lateral lumbar disc herniation, offering high patient satisfaction. Symptom duration and preoperative radicular VAS scores are key predictors of positive outcomes. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.