Percutaneous Endoscopic Backhand Holding (EBH) Technique for Extraforaminal Lumbar Disc Herniations: A Modified Operative Technique.

Abstract

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical (MIS) procedure rapidly improved in the surgical treatment of lumbar disc herniation (LDH). For the treatment of extraforaminal lumbar disc herniations (ELDH), microendoscopic discectomy (MED) or traditional Transforaminal Lumbar Interbody Fusion (MIS-TLIF) are commonly used, but limitations exist due to bony resection. Many classic surgical approaches for PELD have inherent disadvantage when removing migrated ELDH.

Objective: We aimed to present the results of a series of PELD cases that were operated using a modified endoscopic backhand holding (EBH) approach for the treatment of ELDH.

Methods: Seventy-two patients diagnosed with ELDH who underwent PELD via the EBH approach from January 2018 to December 2022 were retrospectively assessed. Pre- and postoperative clinical data, radiographic findings, and surgical techniques were investigated. Neurological recovery examinations were performed preoperatively and at 3 days, 1 month, 3 months, 6 months, 1 year postoperatively.

Results: No major intraoperative complications were noted. Significant improvement in back and leg pain was observed in visual analogue scale (VAS) score, and the mean ODI was decreased from preoperative 78% (range = 60-98%) to postoperative 30% (20-40%) (P < 0.001) at 1-month follow-up and obtained further improvement at 1 year (mean ODI = 11%; range = 2-20%). All patients showed progressive improvement in their initial neurological deficits, with complete recovery of motor weakness. According to the Macnab criteria, overall excellent and good outcomes were obtained in 67 patients (95.7%) - 57 excellent (81.4%), and 10 (14.3%) good - with fair outcomes in three patients (4.3%) at the time of last follow-up.

Conclusion: Percutaneous endoscopic backhand holding is a minimally invasive, safe, valuable, and efficacious surgical procedure for treating ELDH. It is important that surgeons perform PELD using the technique they know best to ensure successful implementation of the surgery.