Objective: The purpose of this study was to analyze the surgical outcomes of carbon dioxide (CO(2)) laser-assisted microdiscectomy for extraforaminal lumbar disc herniations (EFLDH) at the L5-S1 level.
Background data: Microdiscectomy via the lateral transmuscular route is beneficial for treating EFLDH at the L5-S1 level. However, this technique may not effectively remove concomitant foraminal lumbar disc herniation (FLDH), resulting in persistent leg pain and a necessity for revision surgery. CO(2) laser-assisted microdiscectomy could be an effective alternative, as it enables effective decompression of EFLDH as well as of the accompanying FLDH, despite a narrow operative window.
Methods: Thirty-one consecutive patients with EFLDH at the L5-S1 level who underwent CO(2) laser-assisted microdiscectomy via the lateral transmuscular route were prospectively enrolled. Clinical outcomes were assessed 1 year after surgery by using the visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), and patient's subjective satisfaction rate.
Results: Of the 31 patients, 10 were male and 21 were female, with a mean age at surgery of 62.2 years. All patients showed improvement in leg pain immediately after surgery. Transient dysesthesia developed in one patient. Of the 28 patients (90.3%) followed for a 1-year period, the mean VAS for back pain and leg pain, as well as the mean ODI, decreased significantly from 5.2, 8.3, and 60.7% to 2.6, 1.8, and 18.1%, respectively. The mean subjective satisfaction rate was 75.7%. Clinical success was observed in 27 patients (96.4%), and reherniation occurred in one patient (3.6%). No patient underwent reoperation for reherniation or segmental instability.
Conclusions: CO(2) laser-assisted microdiscectomy for EFLDH at the L5-S1 level showed satisfactory surgical results at the 1-year follow-up.