Transforaminal microtubular discectomy for extraforaminal disc herniation using a 14-mm retractor.

STUDY

DESIGN

Retrospective observational study.

PURPOSE: We report our experience with minimally invasive transforaminal (TF) microtubular discectomy using a 14-mm tubular retractor in 20 patients with extraforaminal (EF) disc herniations.

OVERVIEW OF LITERATURE: Despite the popularity of the TF approach with an open and endoscopic approach, little is known regarding TF microtubular discectomy using a 14-mm diameter tubular retractor.

METHODS

A group of 20 patients who failed conservative treatment underwent surgery via the TF approach using a 14-mm tubular retractor from March 2018 to January 2024. Preoperative and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were monitored.

RESULTS

A 14-mm tube over the METRx system (Medtronic-Sofamor-Danek) was successfully utilized in all patients. The mean intraoperative blood loss was 29.85±7.02 mL, whereas the mean operative time was 30.50±5.38 minutes. The affected levels were L3-L4 (eight patients), L4-L5 (five patients), L5-S1 (four patients), and L2-L3 (three patients). The VAS score for the leg improved from 7.6±0.77 to 2.0±0.56 immediate after surgery (p <0.001), whereas the postoperative VAS score for the back was 1.23±0.83. The mean ODI score improved significantly from 57.20%±9.36% before surgery to 12.60%±3.18% at 1 year after surgery (p <0.001). One patient had L5-S1 EF recurrent herniation.

CONCLUSIONS

TF microtubular discectomy using a 14-mm tubular retractor offers an adequately sized foraminal working channel for effective decompression of the EF disc herniation while reducing pain, improving functional outcomes, and preserving integrity.