Endoscopic Transforaminal Discectomy Vs. Far Lateral Discectomy for Extraforaminal Disc Protrusions: Our Experience

Background: Extraforaminal disc herniations are challenging occurrences, requiring a more disruptive approach in terms of bony removal and muscles dissection. We compared outcomes and intraoperative findings between endoscopic transforaminal and far lateral discectomy in the treatment of extraforaminal disc protrusions Methods: We prospectively collected 38 patients who underwent surgery for lumbar extraforaminal disc prolapse, from January 2014 to December 2018. Twenty patients underwent far lateral microsurgical discectomy, whereas eighteen a percutaneous transforaminal endoscopic discectomy. Patients were randomly assigned to a treatment group and were followed-up at intervals of 3, 6, and 16 months. No patients were lost at follow-up. Data were collected on leg pain and disability degree, preoperatively and at follow-up visits, along with demographic data, operative time, amount of intraoperative blood loss, and any postoperative surgical adverse events. Eventually, data analyzed and compared between the two groups. Results: Mean operative time was significantly shorter for endoscopically treated patients compared to patients who underwent microdiscectomy (59.4 vs. 98 minutes, p-value < 0.001). Also, intraoperative blood loss was almost negligible (< 50 ml) for all endoscopically treated patients. There were no differences in terms of postoperative outcomes between patients treated with standard microsurgical techniques and patient who underwent endoscopic transforaminal discectomy at 3, 6, and 16 months of follow-up. Conclusions: transforaminal endoscopic discectomy is a feasible and safe procedure for the treatment of extraforaminal lumbar disc herniation. Our series highlighted the utility and feasibility of the technique, showing similar results to far lateral microsurgical technique.