الفهرس 
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Abstract
Transforaminal endoscopic discectomy showed similar clinical outcomes and rate of complication of the gold standard microdiscectomy at one year follow up as regard VAS for back pain, VAS for leg pain and ODI score. The transforaminal endoscopic discectomy showed superiority over microdiscectomy as regard reduction of VAS of back pain at 3 months follow up, less blood loss, shorter hospital stay duration and faster return to work but with increased hazards of high intraoperative radiation exposure.
Shifting to endoscopic spine surgery in patients indicated for discectomy encounters many barriers including the initial high costs of the instruments and disposables, health insurance authorization for such surgeries and the steep learning curve for surgeons.
In Ain Shams University Hospitals; funds were allocated for foundation of endoscopic spine surgery unit including a training center in order to add the endoscopic spine surgery techniques to the armamentarium of spine surgeons and help surgeons to overcome the steep learning curve.
Although the microdiscectomy is still the gold standard surgical management for lumbar disc herniation in many centers including Ain Shams University Hospitals, full-endoscopic transforaminal discectomy had gained popularity among surgeons as an alternate to the standard surgery in many cases.
This study aims to compare the clinical outcomes, operative data and complications of the treatment of lumbar disc herniation with the “percutaneous full endoscopic transforaminal discectomy technique” (TED) and the gold standard “Open microdiscectomy technique” (MD).
This is a Randomized controlled study carried out at Ain Shams University hospitals which included 30 patients with single level lumbar disc prolapse; 15 patients underwent full endoscopic transforaminal discectomy (TED) and 15 patients underwent open microdiscectomy (MD).
There was no statistically significance difference between the two groups as regard the improvement of Visual analogue scale (VAS) for leg pain, VAS for back pain and ODI score at the end of the follow up at 1 year. As regard the VAS for leg pain, it showed improvement from 8.55 (± 0.16) to 1.37 (± 0.15) in TED group and from 8.37 (± 0.16) to 1.55 (± 0.15) in MD group with no statistically significant difference. The VAS for back pain also improved in the two groups; from preoperatively 5.7 (± 0.23) to postoperatively 1.91 (± 0.17) in the TED group and from 5.36 (± 0.23) to 2.36 (± 0.17) in MD group. At the end of follow up ODI score was 14.14 (± 0.99) and 16.86 (± 0.99) in TED and MD respectively with no statistically significant difference.
There was statistically significant difference between the two groups as regard operative time, blood loss and hospital stay between the two groups. The operative time in minutes was 51.07 (± 11.84) in the TED group and 61.2 (± 12.96) in the MD group. The mean estimated amount of blood loss was 77.33 CC (± 23.14) in the TED group and 170 CC (± 56.06) in the MD group. The mean duration of hospital stay in days was shorter in the TED group with mean value 1 (± 0) and 2 (± 0.85) in the MD group. Exposure to radiation in minutes was 1.09 (± 0.33) and 0.18 (± 0.08) in the TED group and MD respectively with significant higher exposure to radiation in the TED group.
The mean time of return to work postoperative was in favor of the TED group The calculated mean time in weeks was
4.69 ± 1 in the TED group and 9.5 ± 2.32 in the MD.
There was no statistically significance difference in rate of complications and recurrence between the two techniques.
Transforaminal endoscopic discectomy showed similar clinical outcomes and rate of complication of the gold standard microdiscectomy at one year follow up as regard VAS for back pain, VAS for leg pain and ODI score. The transforaminal endoscopic discectomy showed superiority over microdiscectomy as regard blood loss, shorter hospital stay duration and faster return to work but with increased hazards of high intraoperative radiation exposure.
In Ain Shams University hospitals; funds were allocated for foundation of endoscopic spine surgery unit including a training center in order to add the endoscopic spine surgery techniques to the armamentarium of spine surgeons and help surgeons to overcome the steep learning curve.