title: Percutaneous Posterolateral Transforaminal Endoscopic Discectomy: Clinical Outcome, Complications, and Learning Curve Evaluation.
abstract: Ongoing technological development combined with better understanding of endoscopic anatomy has made posterolateral endoscopic discectomy an appealing surgical option for the management of herniated lumbar disc. We evaluated clinical outcomes, complication rates, and surgical learning curve with the percutaneous posterolateral transforaminal endoscopic discectomy technique (PPTED). PPTED was performed on 150 patients from 2004 to 2008. And 124 patients were available for follow-up. Data regarding pain, postoperative complications, neurological status, operation time, and subjective patient satisfaction were recorded. A satisfactory clinical outcome as reflected in the VAS (mean 3.6) and ODI improvement (mean 21%) scores was reported; 20.9% of the patients required additional surgery. Learning curve assessment showed a significant difference (p = 0.043) for fewer revision surgeries as surgeons became more experienced. Patients who had endoscopic discectomy as a primary surgery achieved significantly lower VAS (p = 0.04) and ODI improvement (p = 0.004) scores compared with patients having transforaminal endoscopic discectomy as revision surgery. The complication rate was 1.6%, including one case of post-surgery hypoesthesia and one deep wound infection. The percutaneous posterolateral transforaminal endoscopic discectomy technique has a satisfactory clinical outcome with a low complication rate. Results for endoscopic surgery for revision or recurrent disc herniation are comparable to those of open revision surgery; the steep learning curve can be overcome with training and suitable patient selection.
authors.affiliation: Resident, Department of Orthopedic Surgery Sheba Medical Center, Tel-Hashomer, Israel The Sackler School of Medicine Tel Aviv University, Israel.
authors.forename: Shay
authors.initials: S
authors.lastname: Tenenbaum
authors.affiliation: Spine Fellow University of Kansas Medical Center Department of Neurosurgery Kansas City, Kansas.
authors.forename: Harel
authors.initials: H
authors.lastname: Arzi
authors.affiliation: Resident, Department of Orthopedic Surgery Sheba Medical Center Tel-Hashomer, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Herman
authors.affiliation: Senior Surgeon, Spine Deformity Unit Department of Orthopedic Surgery Sheba Medical Center Tel-Hashomer, Israel, The Sackler School of Medicine Tel Aviv University, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Friedlander
authors.affiliation: Senior Surgeon, Spine Deformity Unit Department of Orthopedic Surgery Sheba Medical Center Tel-Hashomer, Israel The Sackler School of Medicine Tel Aviv University, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Levinkopf
authors.affiliation: Professor of Neurosurgery, Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.affiliation: Senior Surgeon, Spine Deformity Unit Department of Orthopedic Surgery Sheba Medical Center Tel-Hashomer, Israel The Sackler School of Medicine Tel Aviv University, Israel.
authors.forename: Isreal
authors.initials: I
authors.lastname: Caspi