title: Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: A single centre's experience using the far lateral approach.
abstract: OBJECTIVE
  Since the turn of the century, minimally invasive surgery has become increasingly widespread. Discectomy surgery has evolved from wide open to microscopic and now endoscopic. This study aims to demonstrate that transforaminal endoscopic discectomy is an alternative and safe approach for degenerative disk surgery.
  
  
  METHODS
  Two year retrospective assessments of patients who underwent transforaminal endoscopic discectomy at a tertiary neurosurgical center in the United Kingdom by a single surgeon. Under strict confidentiality, data was collected from online patient data and PACS systems. Patient feedback was achieved using phone call follow up and clinic appointments. Standard statistical analysis was performed.
  
  
  RESULTS
  201 patients had endoscopic discectomy and the mean age was 41 years. Male:female ratio was 1.3:1.0. Mean time of onset of symptoms was 5.5 months and the most common level was L4/5 (53%). All endoscopic discectomies were performed under local anesthesia. Theater time was on average 110 min. 10 patients were lost to follow up. 95% of patients were discharged within 7h post operatively. Visual acuity score of the pain dropped from an average of 7/10 pre-operatively to 0-1/10 in 95% of patients two weeks post operatively. 87% patients went back to their normal daily activities within two weeks. There were no cases of CSF leak, hematoma formation or wound infection. 1% of patients developed a nerve root injury. 6% of patients had recurrent herniation and require microdiscectomy.
  
  
  CONCLUSIONS
  Endoscopic discectomy can be an alternative approach to microdiscectomy. While it can take more expertise to perform endoscopic discectomy, our data shows that the far lateral endoscopic discectomy using the TESSYS technique has comparable outcomes to microdiscectomy.
authors.affiliation: Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Sanusi
authors.affiliation: Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. Electronic address: js.davis1989@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Nicassio
authors.affiliation: Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
authors.forename: I
authors.initials: I
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
keywords: Degenerative disk disease; Local anesthesia; Minimally invasive surgery; Transforaminal endoscopic discectomy