Abstract

Background: Chronic low back pain secondary to lumbar disc herniation is common and debilitating to patients. Those patients who do not respond to conservative management are traditionally treated with open lumbar discectomy. With the advent of Minimally Invasive Spine Surgery (MISS) technique, Transforaminal Percutaneous Endoscopic Discectomy (TPED) has been practiced with much success. In contrast to open discectomy, TPED breaches only the skin and subcutaneous tissue from the lateral aspect, minimizing trauma to the soft tissue. Nevertheless, the documented clinical outcome of this new technique is scarce among the Malaysian population. We aim to present clinical outcomes of TPED among the Malaysian population.

Methods: All patients who had undergone treatment for prolapsed intervertebral discs at Hospital Sultan Ismail, Johor Bahru, from 1st of January 2019 to 1st of June 2020 were screened for suitability to be included in this retrospective study. Patients who had undergone TPED at this centre were recruited. Those who underwent open discectomy were excluded. Only patients with minimum 1-year follow-up were included in this study. Patient characteristics were presented descriptively. Analysis of the pre-operative and post-operative Visual Analogue Scale (VAS) and Oswestry Disability Index was done with SPSS V21.0 (IBM, Armonk, NY).

Results: A total of 30 patients were included in this study with a mean age of 40.7 years. Majority of patients (n=25; 83.3%) presented with radiculopathy only. The mean duration of symptoms was 6.5 months. Most patients had diseased discs at L4/L5 (n=15; 50%) and L5/S1 (n=8; 26.7%) with subarticular region as the most common location of disc protrusion (n=18; 60%). The patients’ mean Visual Analogue Scale (VAS) score significantly reduced from 6.3 to 2.2 at post-operative 1 month, 2.4 at post-operative 6 months and 2.0 at post-operative 1 year (p<0.001). The mean Oswestry Disability Index significantly improved from 45.1 to 22.0 after the surgery (p<0.001). More than three-quarter of patients had excellent (n=10; 33.3%) and good (n=11; 36.7%) outcomes based on the Macnab criteria. Only three patients had complications (nerve root injury, recurrence, and skin irritation). There was no association between Macnab outcomes and patients’ characteristics.

Conclusion: TPED is safe and effective in managing patients with prolapsed intervertebral discs among the Malaysian population. Improvement in terms of visual analogue score and Oswestry Disability Index is significant up to 1 year after TPED.