Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Abstract

Background

The aims of this paper are to introduce Open spinal endoscopy (OSE), which is a new single hole split-type spinal endoscopic technique that can achieve adequate decompression and lumbar discectomy with preservation of the facet joints and posterior ligamentous complex, and to determine whether it can be widely performed.

Methods

Data from 58 patients who were treated for lumbar disc herniation using the open spinal endoscopic technique at Anhui No. 2 Provincial People's Hospital between July, 2021 and February, 2022 were retrospectively analyzed. Pain in the lower back and legs was evaluated using the visual analog scale (VAS) score, neurologic status by the Japanese Orthopedic Association (JOA) score, and degree of disability by the Oswestry Disability Index (ODI). These evaluations were performed on the day before surgery and at the final postoperative follow-up. Surgical outcomes were assessed using the modified MacNab criteria. The method described by Dohzono and Matsumura was used to evaluate facet joint preservation.

Results

After surgery, the VAS score decreased from 8.4 ± 3.1 to 0.8 ± 0.8 (p < 0.005) for leg pain and from 5.4 ± 2.9 to 1.8 ± 1.5 (p < 0.05) for back pain. The JOA score improved from 14.7 ± 8.2 to 23.7 ± 4.8 (p < 0.005). The average rate of improvement in the JOA score was 74.7% ± 34.7%. The ODI decreased from 46.1 ± 5.8 to 14.6 ± 7.0 (p < 0.005). The final clinical outcome was excellent in 47 patients (81.0%), good in 10 (17.3%), and fair in one (1.7%). No patient had a poor final outcome. There were few operative complications. Dural injury occurred during use of the endoscope in two patients. The facet joint was preserved in 83.5% ± 7.4% of cases on the approach side and in 94.5% ± 7.3% on the contralateral side.

Conclusions

OSE is a single hole split-type endoscopic technology. Compared with that for other minimally invasive spinal endoscopic techniques, the learning curve is less steep and easier to master. Open spinal endoscopy can achieve adequate decompression and lumbar discectomy with preservation of the facet joints and posterior ligamentous complex and can be performed widely.