Technical challenges and surgical outcomes of percutaneous transforaminal endoscopic discectomy in patients with upper lumbar disc herniation: a prospective clinical study

Introduction Upper lumbar disc herniation (ULDH) constitutes a considerably complex and rare anatomic entity. As such, there are only a handful of studies investigating the application of percutaneous transforaminal endoscopic discectomy (PTED) in the management of this cause of low back pain. Research question To elucidate the safety and effectiveness of PTED in patients with ULDH. Materials and Methods Twenty-six (26) individuals with diagnosed ULDH (L1–L2, L2–L3) according to clinical and radiologic criteria were prospectively evaluated in a 2-year follow-up period. All patients were assessed preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively. Clinical evaluation was conducted with visual analogue scale for lower limb (VAS-LP) and low back (VAS-BP) pain in conjunction with Short-Form 36 (SF-36) Medical Health Survey Questionnaire. Potential complications were recorded in each follow-up interval. Results One patient (3.8%) featured temporary postoperative dysesthesia that was completely resolved at 6 weeks. No other major perioperative complications were observed. Values of all studied indices were found to be statistically significantly ameliorated at the end of follow-up. Improvement was depicted to be quantitatively maximal at 6 weeks postoperatively. Conclusions PTED constitutes a safe and effective technique for surgical management of ULDH that merits further assessment in current clinical practice in the framework of multicenter randomized controlled trials. Level of evidence Level III.