Uniportal Endoscopic Microdiscectomy Is an Effective Treatment Option for Far-Lateral Lumbar Disk Herniations

Background: Far-lateral lumbar disk herniation (FLLDH) poses a surgical challenge given the difficulty in visualizing the pathology with traditional techniques. Endoscopic microdiscectomy is a novel technique for the treatment of FLLDH with decreased soft tissue disruption. Purposes: We sought to compare the efficacy of tubular versus endoscopic microdiscectomy for FLLDH. Methods: A retrospective cohort study was performed that included patients undergoing uniportal endoscopic or tubular decompression for FLLDH over a 5-year period. The primary outcome was patient-reported outcome measures (PROMs). Secondary outcomes included operative time, intraoperative radiation, length of stay (LOS), and reoperation/complication rates. Comparisons between non-paired continuous variables were done with a 2-tailed independent sample t-test. Categorical variables were compared with a χ² or a Fisher exact test. Significance was assumed at P < .05. Results: We identified 135 patients, 64 having undergone endoscopic and 71 tubular microdiscectomy. There were no differences in operative times (67.7 vs 68.2 minutes) or LOS (945.5 vs 911.1 minutes). Endoscopic microdiscectomy was associated with increased total fluoroscopy time (105.92 vs 34.66 seconds) and intraoperative radiation dose (33.68 vs 19.12 mGy). Postoperatively, both groups had statistically significant improvements in all PROMs at early and late follow-up. There was no difference in the magnitude of improvement or the rate of postoperative complications/reoperations between the groups. Conclusion: This retrospective review found that endoscopic microdiscectomy and tubular decompression were effective techniques for the treatment of FLLDH, showing significant improvement in postoperative PROMs and no differences in postoperative complications. However, endoscopic microdiscectomy is associated with increased intraoperative radiation exposure.