Outcomes of Surgical Management of Foraminal and Extraforaminal Lumbar Disc Herniation

Ezandah, Tarek Mohamed Sghayer Ahme; Abd – Wanes, Atef Kilani; Abd-Fattah, Ahmed Mohamed Ezzat; Rashed, Magdy El Sayed Hassan

doi:10.21608/zumj.2024.319574.3574

Outcomes of Surgical Management of Foraminal and Extraforaminal Lumbar Disc Herniation

Document Type : Original Article

Authors

Neurosurgery Department, Faculty of medicine-Zagazig university

10.21608/zumj.2024.319574.3574

Abstract

Background: Lumbar disc herniations (LDH) can compress nerves, causing back and leg pain. Foraminal herniations affect 10% of LDHs and do not involve spinal canal compression. Partial medial pars resection, an endoscopic spine surgery (ESS), is less invasive than open discectomy.

So, we aimed to analyze outcome of surgical management of foraminal and extraforaminal lumbar disc herniation.

Methods: At Zagazig University Hospitals we evaluated 18 patients with single level foraminal or extraforaminal lumbar disc herniation, validated by MRI and unresponsive to 6 weeks of conservative treatment. Infections, serious chronic diseases, psychological issues, and age above 75 were eliminated. Medical history, neurological and spinal status, and operation outcomes were reviewed. Pain, spinal stability, postoperative recovery, and patient satisfaction were measured.

Results: No significant differences were seen in age, gender, employment position, or comorbidities. Significantly(P<0.0001), the Endoscopic group had the shortest incision length. Operative time, blood loss, and hospital stay differed significantly(P<0.0001), with Paramedian group having shorter operative time and Endoscopic group having less blood loss. The Paramedian + TLIF fusion group demonstrated significant spinal deviation(P=0.0273) and instability(P=0.0058). In the immediate postoperative phase, the Paramedian + TLIF fusion group had significantly higher VAS values than the Endoscopic group(P<0.05). The endoscopic group had greater 6-month ODI(P=0.0135). Macnab criteria were similar (pain: P=0.99; excellent mobility: P=0.7985; good mobility: P=0.5134).

Conclusion: Endoscopic foraminal and extraforaminal lumbar disc herniation treatments had shorter hospital stays, less blood loss, and comparable pain relief and mobility to paramedian and Paramedian + TLIF fusion surgeries. Endoscopic treatments are simpler.

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