A new surgical method to treat intracanal lumbar disc herniation using the unilateral biportal endoscopic transforaminal approach: patient series

Tomohide Segawa; Hiroki Iwai; Hirohiko Inanami; Yuichi Takano; Yohei Yuzawa; Takeshi Kaneko; Kenta Taniguchi; Kazuyoshi Yanagisawa; Junichi Yokosuka; Ryoji Tominaga; Hideki Nakamoto; Katsuyuki Sasaki; Hisashi Koga

doi:10.3171/CASE23608

A new surgical method to treat intracanal lumbar disc herniation using the unilateral biportal endoscopic transforaminal approach: patient series

J Neurosurg Case Lessons. 2024 Jan 29;7(5):CASE23608. doi: 10.3171/CASE23608. Print 2024 Jan 29.

Authors

Tomohide Segawa¹, Hiroki Iwai^{1

2

3}, Hirohiko Inanami^{1

2

3}, Yuichi Takano^{1

2}, Yohei Yuzawa¹, Takeshi Kaneko¹, Kenta Taniguchi¹, Kazuyoshi Yanagisawa^{1

2}, Junichi Yokosuka¹, Ryoji Tominaga², Hideki Nakamoto^{1

4}, Katsuyuki Sasaki^{1

4}, Hisashi Koga^{2

3}

Affiliations

¹ 1Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.
² 2Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.
³ 3Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan; and.
⁴ 4Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.

Abstract

Background: Unilateral biportal endoscopic lumbar discectomy (UBELD) is a new minimally invasive spine surgery. The purpose of this study is to describe a new surgical method to treat intracanal lumbar disc herniation (LDH) using the unilateral biportal endoscopic transforaminal approach (UBE-TFA). The first 15 patients who had undergone UBELD for single-level LDH were included in this study. Operative time, intraoperative blood loss, postoperative stay, and intraoperative complications were recorded. The Oswestry Disability Index (ODI), numeric rating scale (NRS) score for leg pain, and modified MacNab criteria were assessed at 3 months postoperatively.

Observations: The mean operative time was 52.0 ± 13.8 minutes. The mean intraoperative blood loss was 10.5 ± 10.2 mL. The mean postoperative stay was 1.1 ± 0.3 days. There were no complications. The postoperative mean ODI was significantly improved from 44.9 ± 14.4 to 7.7 ± 11.2 at the final follow-up (p < 0.001). There was a significant decrease in the postoperative mean NRS score for leg pain, from 6.1 ± 1.9 to 0.8 ± 1.3 at the final follow-up (p < 0.001). Based on the modified MacNab criteria, good to excellent results were obtained in 86.7% of the patients.

Lessons: We considered UBELD-TFA as not only one of the promising surgical methods for UBELD, but also a new surgical implementation of the TFA.

Keywords: full endoscopic discectomy; lumbar disc herniation; transforaminal approach; unilateral biportal endoscopic spine surgery; unilateral biportal endoscopy.