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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1805018
Original Article

Transforaminal Percutaneous Endoscopic Discectomy for L3/4 and L4/5 Foraminal and Extraforaminal Lumbar Disc Herniation: Clinical Outcomes and Technical Note

Pritsanai Pruttikul
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Tinnakorn Pluemvitayaporn 
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Mana Bannachirakul
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Suttinont Surapuchong
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
2   Research Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Piyabuth Kittithamvongs
2   Research Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Warot Ratanakoosakul
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Kitjapat Tiracharnvut
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Chaiwat Piyasakulkaew
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Sombat Kunakornsawat
1   Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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Abstract

Study Design

Retrospective cohort study.

Background

Foraminal and extraforaminal disc herniations account for 7 to 12% of lumbar herniated discs. Various surgical methods, including midline approaches with facetectomy and paramedian techniques, involve significant bone removal, risking spinal instability. The percutaneous transforaminal approach for endoscopic access to lateral disc herniations presents several advantages over traditional techniques and may be more suitable for these cases.

Objectives

This article evaluates the clinical outcomes and potential complications associated with the treatment of foraminal and extraforaminal lumbar disc herniations at the L3/4 and L4/5 levels in patients who have undergone transforaminal percutaneous endoscopic lumbar discectomy.

Materials and Methods

Between 2016 and 2020, a total of 32 patients diagnosed with single-level lumbar disc herniation at the L3/4 or L4/5 foraminal or extraforaminal levels, who had not responded to conservative management, underwent transforaminal endoscopic discectomy. Follow-up evaluations were performed on postoperative day 1 and at 2 weeks, 6 weeks, 3 months, and 12 months. Both pre- and postoperative assessments employed the visual analog scale (VAS) and the Oswestry Disability Index (ODI) to quantify pain levels and functional outcomes. Clinical outcomes were assessed according to the MacNab criteria to determine the efficacy of the surgical intervention.

Results

The average age of patients was 52.6 years, with L4/5 (81.3%) and L3/4 (18.7%) being the most affected levels. The median follow-up was 18.2 months (range, 1–44 months). There was a significant reduction in VAS and ODI scores at follow-ups compared to preoperative levels (p < 0.01). All patients with preoperative neurological deficits improved, though six patients (18.7%) experienced transient dysesthesia that resolved in 6 weeks. Per the MacNab criteria, clinical efficacy was excellent in 56.3% of patients, good in 37.5%, and fair in 6.2%.

Conclusion

Transforaminal endoscopic lumbar discectomy is a safe and effective minimally invasive procedure for foraminal and extraforaminal lumbar disc herniations at the L3/4 and L4/5 levels. It preserves spinal stability, minimizes blood loss, reduces postoperative pain, and allows for quicker recovery, presenting a strong alternative for patients needing surgery for these conditions.

Keywords

foraminal lumbar disc herniation - far lateral lumbar disc herniation - transforaminal endoscopic discectomy

Ethical Approval

The study was approved by the ethics committee of Lerdsin Hospital.




Publication History

Article published online:
10 March 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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