Amyand's hernia in an eighteen month old boy: A case report.

BACKGROUND

Endoscopic lumbar discectomy is less invasive than traditional microdiscectomy (MD); however, a learning curve is required for surgeons to acquire familiarity and efficiency. Our research question was as follows: how do patient outcomes after endoscopic lumbar disc surgery compare with outcomes after the current gold standard, MD, and does the surgeon's experience affect outcomes?

METHODS

We describe a retrospective French cohort of adults with lumbar disc herniation who received endoscopic discectomy (ED; intralaminar or transforaminal) between February 2020 and May 2022 (ED series) and those who underwent open MD before February 2020 (MD series) in the same center. We reviewed perioperative data, clinical outcomes, and safety data and analyzed the ED learning curve with the Cumulative Sum method.

RESULTS

The ED series included 295 patients (151 transforaminal and 144 interlaminar procedures) and 214 in the MD series. Mean operative time was longer for ED (61.7 minutes) than for MD (51.1 minutes), but hospital stay was shorter (ED: 1.4 nights, MD: 2.5 nights). Lower back pain and leg pain measures significantly improved in both series. Nonsurgical complications and reoperations were less frequent after ED than after MD (4.1% vs 14.5% and 6.4% vs 8.9%, respectively). The cumulative sum analysis showed a learning curve for surgeons, with a reduction in operative time for both ED techniques as experience increased. Mean operative time was significantly longer for the transforaminal approach than for the interlaminar approach.

CONCLUSIONS

Clinical outcomes after ED are similar to those after MD, with some advantages for ED, including lower rates of complications and shorter hospital stays. Transforaminal ED requires a longer operative time than interlaminar, but operative time reduces with a learning curve for both techniques.

CLINICAL RELEVANCE: Endoscopic lumbar disc surgery should be considered as a feasible alternative to MD for lumbar disc herniation surgery that results in fewer complications and shorter hospital stays.