CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 312-320
DOI: 10.1055/s-0043-1769756
Original Article

Outcome of Transforaminal Endoscopic Discectomy in Rural India in a Single-Level Lumbar Disc Prolapse Under Local Anesthesia

Vishnu Vikraman Nair
1   Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Sarabjeet Kohli
1   Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Nilesh Vishwakarma
1   Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Juilee Mhatre
1   Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
› Author Affiliations


Aim The aim of this study was to undertake a clinical study to evaluate the outcomes of transforaminal endoscopic discectomy under local anesthesia and to study the complication rate.

Study Design It is a prospective study.

Methods We prospectively analyzed outcomes of 60 patients with a single-level lumbar disc prolapse in rural India from December 2018 to April 2020 who underwent endoscopic discectomy under local anesthesia. Follow-up was done using the visual analogue score (VAS) and Oswestry Disability Index (ODI) scoring systems with a minimum follow-up up to 1 year postoperatively.

Results In our study of 60 patients, there was 38 cases of L4-L5 disc pathology, 13 L5–S1 discs, and 9 L3-L4 discs. Our study showed a significant clinical reduction in mean VAS score that was 7.07/10 preoperatively and reduced to 3.88/10 at the third month and 3.64/10 at 1 year of follow-up (p-value < 0.05) showing clinical significance. The ODI scoring done preoperatively was an average mean of 57.37% pointing to how crippled the patients were with lumbar disc prolapse and showed a significant reduction to 29.32% postoperatively at 1 year (p-value < 0.05) showing clinical significance. This reduction in ODI directly corelates to how almost all patients returned to normal life coping to all activities and were completely pain free at 1 year of follow-up.

Conclusion Endoscopic spine surgery in lumbar disc prolapse is highly effective and can deliver a good functional outcome if done with correct preoperative planning and approach.


The paper was presented at IOA – CON 2021, organized by the Indian Orthopaedics Association, held in Goa, India, between December 21 and 25, 2021.

Publication History

Article published online:
16 June 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001; 344 (05) 363-370
  • 2 Reisbord LS, Greenland S. Factors associated with self-reported back-pain prevalence: a population-based study. J Chronic Dis 1985; 38 (08) 691-702
  • 3 Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine 1995; 20 (11) 1307-1314
  • 4 Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res 1982; (165) 110-123
  • 5 Spiliopoulou I, Korovessis P, Konstantinou D, Dimitracopoulos G. IgG and IgM concentration in the prolapsed human intervertebral disc and sciatica etiology. Spine 1994; 19 (12) 1320-1323
  • 6 Arai Y, Yasuma T, Shitoto K, Yamauchi Y, Suzuki F. Immunohistological study of intervertebral disc herniation of lumbar spine. J Orthop Sci 2000; 5 (03) 229-231
  • 7 Hatano E, Fujita T, Ueda Y. et al. Expression of ADAMTS-4 (aggrecanase-1) and possible involvement in regression of lumbar disc herniation. Spine 2006; 31 (13) 1426-1432
  • 8 Kellgren JH. Referred pains from muscle. BMJ 1938; 1 (4023): 325-327
  • 9 Weinstein SL, Buckwalter JA. Turek's Orthopaedics: Principles and Their Application. Philadelphia: Lippincott Williams & Wilkins; 2005
  • 10 Jordan J, Konstantinou K, O'Dowd J. Herniated lumbar disc. Clin Evid 2009; 2009: 1118
  • 11 Bono CM, Wisneski R, Garfin SR. Lumbar disc herniations. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA. eds. The Spine. 5th ed.. Philadelphia, PA: Saunders; 2006
  • 12 Carragee E. Surgical treatment of lumbar disk disorders. JAMA 2006; 296 (20) 2485-2487
  • 13 Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med 1986; 315 (17) 1064-1070
  • 4 Malmivaara A, Häkkinen U, Aro T. et al. The treatment of acute low back pain–bed rest, exercises, or ordinary activity?. N Engl J Med 1995; 332 (06) 351-355
  • 15 Dandy WE, Peltier LF. Loose cartilage from intervertebral disk simulating tumor of the spinal cord. By Walter E. Dandy, 1929. Clin Orthop Relat Res 1989; 238 (238) 4-8
  • 16 Choi G, Pophale CS, Patel B, Uniyal P. Endoscopic Spine Surgery. [published correction appears in J Korean Neurosurg Soc. 2019 May;62(3):366] J Korean Neurosurg Soc 2017; 60 (05) 485-497
  • 17 Sencer A, Yorukoglu AG, Akcakaya MO. et al. Fully endoscopic interlaminar and transforaminal lumbar discectomy: short-term clinical results of 163 surgically treated patients. World Neurosurg 2014; 82 (05) 884-890
  • 18 Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M. Transforaminal endoscopic surgery for lumbar stenosis: a systematic review. Eur Spine J 2010; 19 (06) 879-886
  • 19 Li Z, Hou S, Shang W, Song K, Zhao H. New instrument for percutaneous posterolateral lumbar foraminoplasty: case series of 134 with instrument design, surgical technique and outcomes. Int J Clin Exp Med 2015; 8 (09) 14672-14679
  • 20 Morgenstern R, Morgenstern C, Yeung AT. The learning curve in foraminal endoscopic discectomy: experience needed to achieve a 90% success rate. SAS J 2007; 1 (03) 100-107
  • 21 Li ZZ, Hou SX, Shang WL, Cao Z, Zhao HL. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: technique notes and 2 years follow-up. Clin Neurol Neurosurg 2016; 143: 90-94
  • 22 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27 (07) 722-731
  • 23 Kondo M, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H. Significance and pitfalls of percutaneous endoscopic lumbar discectomy for large central lumbar disc herniation. J Spine Surg 2018; 4 (01) 79-85
  • 24 Li X, Han Y, Di Z. et al. Percutaneous endoscopic lumbar discectomy for lumbar disc herniation. J Clin Neurosci 2016; 33: 19-27
  • 25 Sairyo K, Chikawa T, Nagamachi A. State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: discectomy, foraminoplasty, and ventral facetectomy. J Orthop Sci 2018; 23 (02) 229-236
  • 26 Kraemer R, Wild A, Haak H, Herdmann J, Krauspe R, Kraemer J. Classification and management of early complications in open lumbar microdiscectomy. Eur Spine J 2003; 12 (03) 239-246
  • 27 Davis RA. A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 1994; 80 (03) 415-421
  • 28 Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 2004; 29 (16) E326-E332
  • 29 Gibson JN, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? - a review. Surgeon 2012; 10 (05) 290-296
  • 30 Chae KH, Ju CI, Lee SM, Kim BW, Kim SY, Kim HS. Strategies for noncontained lumbar disc herniation by an endoscopic approach: transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction CT with discogram. J Korean Neurosurg Soc 2009; 46 (04) 312-316
  • 31 Choi KC, Lee JH, Kim JS. et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery 2015; 76 (04) 372-380 , discussion 380–381, quiz 381
  • 32 Kulkarni AG, Bassi A, Dhruv A. Microendoscopic lumbar discectomy: technique and results of 188 cases. Indian J Orthop 2014; 48 (01) 81-87
  • 33 Lee JS, Park YM, Ha KY, Cho SW, Bak GH, Kim KW. Preoperative anxiety about spinal surgery under general anesthesia. Eur Spine J 2016; 25 (03) 698-707 DOI: 10.1007/s00586-015-3788-2. . Epub 2015 Feb 11. PMID: 25670066