Arthroscopic microdiscectomy: comparison of preoperative and postoperative imaging studies

Forty-three patients with symptomatic lumbar disc herniations underwent paralumbar arthroscopic disc extraction by a uniportal or biportal approach and postoperative imaging studies. Thirty-one patients were subjected to immediate postoperative computed tomography (CT) at the operative site. The other 12 underwent magnetic resonance imaging (MRI at varying times postoperatively. Images obtained before and after surgery were magnified; the herniation area (H) and the spinal canal area (C) were measured by computerized digitization. The H/C ratio was calculated, and the percentage of canal clearance was obtained in each case. Immediate postoperative CT imaging in 16 of 18 patients with subligamentous and extraligamentous nonmigrated herniation showed a significant change in the external geometry of the annulus and canal clearance (75% to 100% canal clearance). Less compelling change in the postoperative CT images was unexpectedly seen with extraforaminal and foraminal herniations. This result may be attributable to limitations in our study methodology and not to inadequate decompression. Follow-up MRI on these patients within 8 weeks postoperatively did eventually show significant change in two cases that were initially not significant. This study confirms that the arthroscopic microdiscectomy technique effectively extracts herniated disc fragments and alters posterior annular contour, including removal of sequestered pieces.