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Awake transforaminal endoscopic lumbar discectomy in an ambulatory surgery center: early clinical outcomes and complications of 100 patients

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Abstract

Purpose

Transforaminal endoscopic discectomy has been found to have equivalent outcomes to traditional discectomy techniques. Controversy exists concerning whether this should be performed under general anesthetic with neuromonitoring or can be safely performed on awake patients without neuromonitoring. This study aimed to evaluate the safety and effectiveness of awake transforaminal endoscopic discectomy in an ambulatory setting.

Methods

100 consecutive patients with lumbar disc herniations treated with transforaminal endoscopic discectomy by a single surgeon were enrolled in the study. All procedures were performed under conscious sedation with local anesthetic. Preoperative and postoperative visual analog scale (VAS) scores were recorded and compared. Time spent in recovery prior to discharge home and complications were also recorded.

Results

Average VAS score improved from a mean of 6.85 to 0.74 (median 7 to 0) immediately postoperatively. The average time spent in Post Anesthesia Care Unit (PACU) prior to discharge was 56.7 min. Average VAS score at 2 weeks was 3.07 (median 2.5). Complication rates were commensurate with published results in the literature. The most common complication was radiculitis, which appears to be more likely with foraminal/extraforaminal herniations at a rate of 20.7%, versus 2.6% for central/paracentral herniations. There were no cases that required conversion to general anesthetic or transfer to a hospital and no permanent nerve injuries in this cohort.

Conclusions

Endoscopic discectomy can safely and successfully be performed in an ambulatory surgery center under conscious sedation and local anesthetic without neuromonitoring. This procedure leads to rapid recovery in the PACU and significantly improved VAS scores postoperatively.

Level of evidence

Level IV.

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Authors and Affiliations

  1. US Navy Bureau of Medicine and Surgery, Newport, RI, USA

    Nathaniel Alexander

  2. Orthopaedic and Neeulogical Surgery, Vanderbilt University, Nashville, USA

    Raymond Gardocki

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  1. Nathaniel Alexander
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  2. Raymond Gardocki
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Correspondence to Nathaniel Alexander.

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Conflict of interest

For Dr. Gardocki: teaching surgeon and consultant for Joimax. Consultant with royalties for Integrity Implants. Consultant with royalties for Spineology consultant with royalties for Arthrex.

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Alexander, N., Gardocki, R. Awake transforaminal endoscopic lumbar discectomy in an ambulatory surgery center: early clinical outcomes and complications of 100 patients. Eur Spine J 32, 2910–2917 (2023). https://doi.org/10.1007/s00586-023-07786-2

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  • DOI: https://doi.org/10.1007/s00586-023-07786-2

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