Introducing Interlaminar Full-Endoscopic Lumbar Discectomy

Background and Study Objective Interlaminar full-endoscopic diskectomy is a minimally
invasive surgical alternative to microdiskectomy for the treatment of lumbar disk
herniation. The authors analyze their surgical results and learning curves during and
after the introductory phase of this surgical technique.
Patients and Methods We present a case review of 76 patients operated on using
interlaminar full-endoscopic diskectomy. We retrospectively analyzed two spinal surgeons’
learning curves in terms of operation time with respect to intraoperative blood
loss, conversion rates, complications, infections, length of hospitalization, need for
rehabilitation, recurrence rates, pain intensity, and opioid use. Patients’ functional
status and Health-related Quality of Life were assessed by follow-up questionnaires for
47 patients, using the North American Spine Society Score and the Short Form 12 in
addition to long-term pain intensity, work capacity, and patient satisfaction with the
operation.
Results A steady state of the learning curve (operation time) of an experienced spinal
surgeon was reached after 40 cases. Supervision by a more experienced surgeon can
shorten the learning curve. The rate of conversions (10%), complications (5%), and
recurrent lumbar disk herniations (28%) did not negatively affect the long-term
outcome in patients operated on before and after the learning phase. Patient satisfaction
was high.
Conclusions The rate of conversions, complications, and recurrent lumbar disk
herniations compared with microdiskectomy combined with the challenging learning
curve should be considered before surgeons adopt this procedure. Supervision by an
endoscopically experienced spinal surgeon during the introductory phase is highly
advisable.
received
April