Endoscopic Intralaminar Approach for the Treatment of Lumbar Disc Herniation.
Almost every surgical approach carries the risk of causing some degree of spinal instability, especially in cases of excessive resection of the lamina and facet joint. This study describes the endoscopic intralaminar approach (ILA) for the treatment of cranially and caudally migrated lumbar disc herniation. Thirty-one patients who underwent endoscopic ILA for 26 caudally and 5 cranially migrated lumbar disc herniations were identified from a prospectively database. At final follow-up, a personal examination and a standardized questionnaire evaluation were conducted, including the Oswestry Disability Index (ODI) and functional outcome according to modified MacNab criteria. In addition, particular reference was given to back pain, leg pain, and repeat procedures. The mean final follow-up was 37.0 months (range, 5-57 months) at which 29 patients attended (93.5%). No leg pain was noted in 95.0%, no back pain in 85.0%, full motor strength in 95.0%, and no sensory deficit in 95.0% of patients with ILA. Clinical success was reported by 95.0% of patients and the mean ODI was 9% in patients with ILA. Ten patients had an enlargement of ILA to conventional laminotomy (32.3%). By comparison of clinical outcome and repeat procedure rate in patients with ILA with patients with enlargement to laminotomy, no significant differences were identified except for higher ODI (i.e., 16%) in patients with enlargement of ILA. Endoscopic ILA is a safe technique for the treatment of cranially and caudally migrated lumbar disc herniations. Careful procedural planning is recommended to protect soft tissue and osseous structures and to achieve excellent clinical outcome.