Transforaminal Endoscopic Lumbar Discectomy Under Local Anesthesia for Small-Sized Lumbar Disc Herniation in Elite...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Minimally Invasive Spine Procedures

Background:

• Symptomatic small lumbar disc herniation (LDH) poses challenges for elite athletes requiring rapid return to play.
• Characterizing clinical and imaging features of small LDH in athletes is crucial.
• Evaluating transforaminal endoscopic lumbar discectomy (TELD) efficacy under local anesthesia is important for this population.

Purpose of the Study:

• To define the clinical and imaging characteristics of small LDH in elite athletes.
• To assess the effectiveness of TELD under local anesthesia for treating small LDH in this group.
• To determine the impact of TELD on return to sport and patient outcomes.

Main Methods:

• Retrospective review of 11 elite athletes (12 discs) undergoing TELD for small LDH (≤25% canal occupancy).
• Preoperative assessment included neurological status and MRI focusing on T2 hyperintensity within or posterior to the posterior longitudinal ligament (PLL).
• Outcomes measured: time to return to sport, recurrence rates, and modified MacNab criteria.

Main Results:

• All athletes had function-limiting radiculopathy despite small herniations (mean AP diameter 3.3 mm).
• T2 hyperintensity in or behind the PLL was observed in all cases.
• Median return to competition was 2.0 months, with 63.6% excellent and 36.4% good modified MacNab outcomes at 26 months follow-up. No recurrences required reoperation.

Conclusions:

• Symptomatic small LDH with T2 hyperintensity in the PLL represents a distinct clinical entity in elite athletes.
• TELD under local anesthesia is a safe and effective treatment for these athletes.
• TELD facilitates a rapid, reliable return to sport with favorable mid-term results, and T2 hyperintensity may guide surgical decisions.