Clinical StudyMicroscopic tubular discectomy for far lateral lumbar disc herniation

- Lumbar discectomy was performed in 24 patients with far lateral disc herniation.
- Tubular retractors were used to reduce muscle trauma.
- Untoward event rates were low, supporting existing data in the literature.
- Efficacy was demonstrated by multiple health-related quality of life measures.
- Tubular discectomy is a valid treatment option for far lateral disc herniation.

Microscopic tubular discectomy (MTD) reduces muscle trauma associated with treatment of far lateral lumbar disc herniation (FLDH), but data from randomised controlled studies concerning its efficacy on posterolateral disc herniation, has failed to demonstrate its superiority over standard open techniques. Importantly concerns have been raised that it may be inferior in terms of relief of leg and back pain. Although several FLDH series show that MTD can deliver excellent outcomes, the volume of literature in this field has remained small and evidence based on health-related quality of life (HRQOL) measures, scarce. In this study we therefore evaluated the role of MTD for FLDH through analysing multiple HRQOL scores collected in a prospective database. We identified 24 patients who underwent MTD through a caudal approach, targeting directly the disc space to minimise traction on the dorsal root ganglion implicated in causing iatrogenic neuralgia. With a mean follow-up of 9.2 months, the improvement in Oswestry Disability Index and Short Form 36 physical functioning and bodily pain scores was 32, (95% confidence interval [CI]: 21-43), 40 (95% CI: 30-51) and 35 (95% CI: 26-43) respectively. The improvement on the Visual Analogue Scale was 38 mm (95% CI: 23-54) and 35 mm (95% CI: 21-48) for leg pain and back pain respectively. There was no postoperative neuralgia noted and no reoperation required. Our data demonstrated clinically meaningful treatment effects and compare favourably with HRQOL surgical outcomes established for posterolateral disc herniation, supporting MTD as a valid treatment option for FLDH.