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

Abstract

Retrospective observational study. 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. 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. 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. 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. 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.