Lumbar Disc Surgery: Results of the Prospective Lumbar Discectomy Study of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons

Abstract The Prospective Lumbar Discectomy Study enrolled 740 patients in a multiphysician, multicenter, consecutive patient protocol to evaluate the indications and efficacy of lumbar discectomy. Five hundred and thirteen patients could be evaluated at 3 months after surgery. Stepwise logistic regression showed that the factors of fraction of pain referred to the back, work-related injury, absence of back pain on straight leg-raise examination, correspondence of leg pain to typical radicular patterns, leg pain on straight leg-raise examination, and reflex asymmetry were independently predictive of good outcome from surgery. Univariate analysis of the cases with different numbers of predictive factors present showed that use of the operating microscope, sensory deficit, central disc bulge, and free disc fragment were correlated with outcome only in subgroups. An analysis of unsatisfactory outcomes showed two patterns: one of failure as a result of mechanical back pain and one of failure as a result of radiculopathy. Factors predictive of outcome did not influence the type of failure, In a stepwise logistic regression analysis, facetectomy and preoperative sensory deficit were associated with increased likelihood of mechanical back pain failure, while preoperative motor deficit was associated with an increased likelihood of radicular failure. The results support several intuitively derived and commonly believed principles of lumbar disc surgery.

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Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

10.21203/rs.3.rs-594596/v1 ◽

2021 ◽

Author(s):

Hai-Chao He ◽

Xiao-qiang LV ◽

Yong-Jin Zhang

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Lumbar Discectomy ◽

Leg Pain ◽

Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

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Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181438 ◽

2018 ◽

Vol 4 (3) ◽

pp. 389

Author(s):

Ansari Ishtyaque Abdul Aziz ◽

Ansari Muqtadeer Abdul Aziz

Keyword(s):

Back Pain ◽

Lumbar Disc ◽

Japanese Orthopaedic Association ◽

Significant Proportion ◽

Scientific Basis ◽

Radicular Pain ◽

Lumbar Discectomy ◽

Leg Pain ◽

Disc Prolapse ◽

Lumbar Disc Prolapse

Background: Back pain constitutes significant proportion of orthopaedic practitioner OPD. Lumbar disc prolapse constitutes important cause of back pain with radiculopathic leg pain. Different techniques have evolved to treat this disorder non-operatively and operatively. Operative techniques vary a lot in the field of spine surgery depending on the surgeon, institute, infrastructure and cost. We present simple, cost effective, cosmetic, operative technique with scientific basis which gives better visualization for decompression of nerve root in this paper called microscopic lumbar discectomy (MLD).Methods: On the basis of inclusion and exclusion criteria 26 patients were operated by microscopic lumbar discectomy (MLD) technique. All the patients were followed up at the interval of 1 month, 3 months and 6 months and assessment was done of subjective and objective findings with Japanese orthopaedic association (JOA) score and rate of improvement (RI) was calculated. Out of 26 patients 18 were men and 8 were women. Age ranges from 28 years to 72 years. Mean age being 47.8 years.Results: Out of 26 patients at the time of discharge, 20 patients (87.5%) could walk independently without any aid and without any radicular pain. In most of the patients 19 (73.07%) sciatica improved immediately. The pre-operative mean±SD (SE) JOA score was 8.346±0.85 (0.169) which improved to 11.807±0.694 (0.136) after 1 month and 13.19±0.895 (0.175) after 6 months.Conclusions: Excellent to good results and improvement can be achieved surgically, economically and cosmetically by microscopic lumbar discectomy technique in the spine lumbar disc prolapse patients at many spine centre with cosmesis, good results and rehabilitation of the patient.

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RECURRENT DISC HERNIATION AND LONG-TERM BACK PAIN AFTER PRIMARY LUMBAR DISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000337574.58662.e2 ◽

2009 ◽

Vol 64 (2) ◽

pp. 338-345 ◽

Cited By ~ 131

Author(s):

Matthew J. McGirt ◽

Giannina L. Garcés Ambrossi ◽

Ghazala Datoo ◽

Daniel M. Sciubba ◽

Timothy F. Witham ◽

...

Keyword(s):

Back Pain ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Medline Search ◽

Recurrent Disc Herniation ◽

Herniated Lumbar Disc ◽

Short And Long Term

Abstract OBJECTIVE It remains unknown whether aggressive disc removal with curettage or limited removal of disc fragment alone with little disc invasion provides a better outcome for the treatment of lumbar disc herniation with radiculopathy. We reviewed the literature to determine whether outcomes reported after limited discectomy (LD) differed from those reported after aggressive discectomy (AD) with regard to long-term back pain or recurrent disc herniation. METHODS A systematic MEDLINE search was performed to identify all studies published between 1980 and 2007 reporting outcomes after AD or LD for a herniated lumbar disc with radiculopathy. The incidence of short- and long-term recurrent back or leg pain and recurrent disc herniation was assessed from each reported LD or AD cohort and the cumulative incidence compared. RESULTS Fifty-four studies (60 discectomy cohorts) met the inclusion criteria, reporting the outcomes of 13 359 patients after lumbar discectomy (LD, 6135 patients; AD, 7224 patients). The reported incidence of short-term recurrent back or leg pain was similar after LD (mean, 14.5%; range, 7–16%) and AD (mean, 14.1%; range, 6–43%) (P < 0.01). However, more than 2 years after surgery, the reported incidence of recurrent back or leg pain was 2.5-fold less after LD (mean, 11.6%; range, 7–16%) compared with AD (mean, 27.8%; range, 19–37%) (P < 0.0001). The reported incidence of recurrent disc herniation after LD (mean, 7%; range, 2–18%) was greater than that reported after AD (mean, 3.5%; range, 0–9.5%) (P < 0.0001). CONCLUSION Review of the literature demonstrates a greater reported incidence of long-term recurrent back and leg pain after AD but a greater reported incidence of recurrent disc herniation after LD. Prospective, randomized trials are needed to firmly assess this possible difference.

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THE ROLE OF LOCAL SOLU-MEDROL IN POSTOPERATIVE PAIN RELIEF AFTER LUMBAR DISC SURGERY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.5.6 ◽

2011 ◽

pp. 40-44

Author(s):

Keyword(s):

Back Pain ◽

Pain Relief ◽

Lumbar Disc ◽

Early Postoperative Period ◽

Leg Pain ◽

Lumbar Disc Surgery ◽

Control Group ◽

Steroid Group ◽

Disc Surgery

Objectives: The aim of this study is to evaluate analgesic effect of local Solu-Medrol in following lumbar disc surgery. Methods: A prospective, randomized case-control study included 49 patients, divided into 2 groups (24: control group, 25: steroid group). After discectomy, a piece of gelfoam soaked with 40 mg Solu-Medrol was left on the affected root in the steroid group. In the control group, saline soaked gelfoam was applied to the nerve root. T test to compare VAS between the two groups. Results: 24 patients (15 males, 9 females) average age of 30.2 in the control group, 25 patients (18 males, 7 females) average aged 29.8 in the steroid group. Average follow-up time 14.5 months for the control group, 14.2 months for the steroid group. Statistically significant back pain and leg pain relief (p<0.01) was observed at 1 week, 2 weeks and 1 month, but it became insignificant after 3 months. Without any complications could be related to the steroid. Conclusions: Local Solu-Medrol 40 mg is a safe and effective method in reducing back pain and radicular leg pain in early postoperative period. Key words: Local Solu-Medrol; Lumbar disc surgery.

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Challenges in the Analysis of Longitudinal Pain Data: Practical Lessons from a Randomized Trial of Annular Closure in Lumbar Disc Surgery

Pain Research and Treatment ◽

10.1155/2019/3498603 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Gerrit J. Bouma ◽

Martin Barth ◽

Larry E. Miller ◽

Sandro Eustacchio ◽

Charlotte Flüh ◽

...

Keyword(s):

Lumbar Disc ◽

Lumbar Discectomy ◽

Pain Severity ◽

Leg Pain ◽

Lumbar Disc Surgery ◽

Integrated Analysis ◽

Pain Scores ◽

Disc Surgery ◽

Unadjusted Analysis

Purpose. To analyze leg pain severity data from a randomized controlled trial (RCT) of lumbar disc surgery using integrated approaches that adjust pain scores collected at scheduled follow-up visits for confounding clinical events occurring between visits. Methods. Data were derived from an RCT of a bone-anchored annular closure device (ACD) following lumbar discectomy versus lumbar discectomy alone (Control) in patients with large postsurgical annular defects. Leg pain was recorded on a 0 to 100 scale at 6 weeks, 3 months, 6 months, 1 year, and 2 years of follow-up. Patients with pain reduction ≥20 points relative to baseline were considered responders. Unadjusted analyses utilized pain scores reported at follow-up visits. Since symptomatic reherniation signifies clinical failure of lumbar discectomy, integrated analyses adjusted pain scores following a symptomatic reherniation by baseline observation carried forward for continuous data or classification as nonresponders for categorical data. Results. Among 550 patients (272 ACD, 278 Control), symptomatic reherniation occurred in 10.3% of ACD patients and in 21.9% of controls (p < 0.001) through 2 years. There was no difference in leg pain scores at the 2-year visit between ACD and controls (12 versus 14; p = 0.33) in unadjusted analyses, but statistically significant differences favoring ACD (19 versus 29; p < 0.001) in integrated analyses. Unadjusted nonresponder rates were 6.0% with ACD and 6.7% with controls (p = 0.89), but 15.7% and 27.8% (p = 0.001) in integrated analyses. The probability of nonresponse was 16.4% with ACD and 18.3% with controls (p = 0.51) in unadjusted analysis, and 23.7% and 31.2% (p = 0.04) in integrated analyses. Conclusion. In an RCT of lumbar disc surgery, an integrated analysis of pain severity that adjusted for the confounding effects of clinical failures occurring between follow-up visits resulted in different conclusions compared to an unadjusted analysis of pain scores reported at follow-up visits only.

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A multicenter, randomized, double-blind, dose-finding study of condoliase in patients with lumbar disc herniation

Journal of Neurosurgery Spine ◽

10.3171/2017.7.spine161327 ◽

2018 ◽

Vol 28 (5) ◽

pp. 499-511 ◽

Cited By ~ 8

Author(s):

Yukihiro Matsuyama ◽

Kazuhiro Chiba ◽

Hisashi Iwata ◽

Takayuki Seo ◽

Yoshiaki Toyama

Keyword(s):

Placebo Group ◽

Back Pain ◽

Lumbar Disc ◽

Keratan Sulfate ◽

Disc Height ◽

Leg Pain ◽

Drug Reactions ◽

End Points ◽

Sf 36 ◽

Straight Leg Raise

OBJECTIVEChemonucleolysis with condoliase has the potential to be a new, less invasive therapeutic option for patients with lumbar disc herniation (LDH). The aim of the present study was to determine the most suitable therapeutic dose of condoliase.METHODSPatients between 20 and 70 years of age with unilateral leg pain, positive findings on the straight leg raise test, and LDH were recruited. All eligible patients were randomly assigned to receive condoliase (1.25, 2.5, or 5 U) or placebo. The primary end point was a change in the worst leg pain from preadministration (baseline) to week 13. The secondary end points were changes from baseline in the following items: worst back pain, Oswestry Disability Index (ODI), SF-36, and neurological examination. For pharmacokinetic and pharmacodynamic analyses, plasma condoliase concentrations and serum keratan sulfate concentrations were measured. The safety end points were adverse events (AEs) and radiographic and MRI parameters. Data on leg pain, back pain, abnormal neurological findings, and imaging parameters were collected until week 52.RESULTSA total of 194 patients received an injection of condoliase or placebo. The mean change in worst leg pain from baseline to week 13 was −31.7 mm (placebo), −46.7 mm (1.25 U), −41.1 mm (2.5 U), and −47.6 mm (5 U). The differences were significant at week 13 in the 1.25-U group (−14.9 mm; 95% CI −28.4 to −1.4 mm; p = 0.03) and 5-U group (−15.9 mm; 95% CI −29.0 to −2.7 mm; p = 0.01) compared with the placebo group. The dose-response improvement in the worst leg pain at week 13 was not significant (p = 0.14). The decrease in the worst leg pain in all 3 condoliase groups was observed from week 1 through week 52. Regarding the other end points, the worst back pain and results of the straight leg raise test, ODI, and SF-36 showed a tendency for sustained improvement in each of the condoliase groups until week 52. In all patients at all time points, plasma condoliase concentrations were below the detectable limit (< 100 μU/ml). Serum keratan sulfate concentrations significantly increased from baseline to 6 hours and 6 weeks after administration in all 3 condoliase groups. No patient died or developed anaphylaxis or neurological sequelae. Five serious AEs occurred in 5 patients (3 patients in the condoliase groups and 2 patients in the placebo group), resolved, and were considered unrelated to the investigational drug. Severe AEs occurred in 10 patients in the condoliase groups and resolved or improved. In the condoliase groups, back pain was the most frequent AE. Modic type 1 change and decrease in disc height were frequent imaging findings. Dose-response relationships were observed for the incidence of adverse drug reactions and decrease in disc height.CONCLUSIONSCondoliase significantly improved clinical symptoms in patients with LDH and was well tolerated. While all 3 doses had similar efficacy, the incidence of adverse drug reactions and decrease in disc height were dose dependent, thereby suggesting that 1.25 U would be the recommended clinical dose of condoliase.Clinical trial registration no.: NCT00634946 (clinicaltrials.gov)

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Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04038-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhaojun Song ◽

Maobo Ran ◽

Juan Luo ◽

Kai Zhang ◽

Yongjie Ye ◽

...

Keyword(s):

Back Pain ◽

Blood Loss ◽

Lumbar Disc ◽

Postoperative Recurrence ◽

Day Surgery ◽

Lumbar Discectomy ◽

Height Ratio ◽

Microendoscopic Discectomy ◽

Endoscopic Lumbar Discectomy

Abstract Background Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD. Methods A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared. Results Patients treated by PELD had lower blood loss and shorter hospital stay (P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014). Conclusions Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.

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Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis

European Spine Journal ◽

10.1007/s00586-019-06272-y ◽

2020 ◽

Vol 29 (7) ◽

pp. 1660-1670 ◽

Cited By ~ 2

Author(s):

A. Rushton ◽

N. R. Heneghan ◽

M. W. Heymans ◽

J. B. Staal ◽

P. Goodwin

Keyword(s):

Back Pain ◽

Clinical Course ◽

Meta Analysis ◽

A Priori ◽

Random Effect ◽

Outcome Data ◽

Lumbar Discectomy ◽

Risk Of Bias ◽

Leg Pain ◽

Meta Analyses

Abstract Purpose To conduct a meta-analysis to describe clinical course of pain and disability in adult patients post-lumbar discectomy (PROSPERO: CRD42015020806). Methods Sensitive topic-based search strategy designed for individual databases was conducted. Patients (> 16 years) following first-time lumbar discectomy for sciatica/radiculopathy with no complications, investigated in inception (point of surgery) prospective cohort studies, were included. Studies including revision surgery or not published in English were excluded. Two reviewers independently searched information sources, assessed eligibility at title/abstract and full-text stages, extracted data, assessed risk of bias (modified QUIPs) and assessed GRADE. Authors were contacted to request raw data where data/variance data were missing. Meta-analyses evaluated outcomes at all available time points using the variance-weighted mean in random-effect meta-analyses. Means and 95% CIs were plotted over time for measurements reported on outcomes of leg pain, back pain and disability. Results A total of 87 studies (n = 31,034) at risk of bias (49 moderate, 38 high) were included. Clinically relevant improvements immediately following surgery (> MCID) for leg pain (0–10, mean before surgery 7.04, 50 studies, n = 14,910 participants) and disability were identified (0–100, mean before surgery 53.33, 48 studies, n = 15,037). Back pain also improved (0–10, mean before surgery 4.72, 53 studies, n = 14,877). Improvement in all outcomes was maintained (to 7 years). Meta-regression analyses to assess the relationship between outcome data and a priori potential covariates found preoperative back pain and disability predictive for outcome. Conclusion Moderate-level evidence supports clinically relevant immediate improvement in leg pain and disability following lumbar discectomy with accompanying improvements in back pain. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

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Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

BioMed Research International ◽

10.1155/2019/9681424 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Xinbo Wu ◽

Guoxin Fan ◽

Shisheng He ◽

Xin Gu ◽

Yunfeng Yang

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Postoperative Complications ◽

Clinical Outcomes ◽

Nucleus Pulposus ◽

Lumbar Disc ◽

Leg Pain ◽

Low Back ◽

Satisfaction Rate ◽

Disc Herniations

Objective. The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods. Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results. Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P<0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions. Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.

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Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis

Operative Neurosurgery ◽

10.1093/ons/opaa360 ◽

2020 ◽

Author(s):

Kuo-Tai Chen ◽

Kyung-Chul Choi ◽

Myung-Soo Song ◽

Hussam Jabri ◽

Yadhu K Lokanath ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Lumbar Decompression ◽

Lateral Recess Stenosis ◽

Endoscopic Discectomy ◽

The Mean

Abstract BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P < .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P < .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.

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