Transforaminal Endoscopic Treatment of Noncompressive Painful Discs With Deficit Under Local Anesthesia: A Retrospective Cohort Study With Long-term Follow-up

Objective: This study investigated the diagnosis and treatment of noncompressive painful lumbar disc with deficit using percutaneous transforaminal endoscopic surgery under local anesthesia, with long-term follow-up of outcomes.Methods: Sixteen patients were included in this single-surgeon retrospective cohort study commencing in 2015, comprising 7 females and 9 males. Disc levels were L4–5 in 12 and L5–S1 in 3 patients, with a mean age of 43.8 years. All patients had no disc compression or high-intensity zone on magnetic resonance imaging (MRI) and underwent functional anesthetic computed tomography (CT) discography. Subsequently, transforaminal endoscopy using the inside-out technique was performed under local anesthesia, involving 3 cardinal steps: clearance of annular degenerated disc material, disc lavage, and radiofrequency cautery. Postoperative MRI and clinical follow-up assessments were conducted.Results: All patients demonstrated a significant decrease in leg visual analogue scale and modified Oswestry Disability Index scores postoperatively. American Spinal Injury Association neurological deficits improved at a mean of 4 months. At a mean follow-up of 53.5 (range, 16–102) months, all patients achieved near-normal activities of daily living and were free of leg pain. Final follow-up MRI revealed evidence of annular healing.Conclusion: Chronic toxic annular tears of noncompressive lumbar discs, presenting with radicular pain, burning, and deficits, can be confirmed by functional anesthetic CT discography and effectively treated with transforaminal endoscopy under local anesthesia, obviating the need for fusion surgery. Neurological recovery follows cessation of chemical leakage from the disc and subsequent annular healing. Transforaminal endoscopy under local anesthesia is the safest, most minimally invasive technique for direct visualization of intra-annular pathology, offering excellent postoperative improvement and sustained long-term results.