Successful Introduction of Full-Endoscopic Lumbar Interlaminar Discectomy in Sweden.

Background: The introduction of full-endoscopic lumbar discectomy (FELD) procedures has made it possible to challenge microscopic discectomy as the gold standard method to treat lumbar disc herniations.

Purpose: The aim of the present study is to investigate the introductory-phase postoperative clinical improvement for FELD patients regarding leg pain, patient-reported outcome measurements (PROMs), complications, reoperations, and learning curve analysis.

Methods: All patients who underwent FELD at Sahlgrenska University Hospital, Sweden, were prospectively included during 2013- 2017. A total of 92 patients were enrolled and followed up for 1 year. The characteristics of the study population, degree of leg pain, complications, learning curve, and PROMs were retrieved from patient records and the National Quality Register for Spine Surgery (Swespine).

Results: The postoperative results demonstrated major improvements; leg pain measured by a numerical rating scale (0-10) decreased from 7.4 ± 2.25 to 2.76 ± 2.70, with a mean improvement of -4.54, (-3.62-5.46) 95% confidence interval (CI). The Oswestry Disability Index decreased by 30.48 (-36.27-23.73) with a 95% CI, and the EuroQol-5D increased by 0.39 (0.21-0.57) 95% CI. An assessment of the final surgical result showed that 91.6% ranked their general situation as better or much better. Specifically, regarding postoperative leg pain, 87% regarded their leg pain as completely gone, much better, or somewhat better, while 13% regarded their leg pain as unchanged or worse. A learning curve analysis showed that for every 10th FELD procedure performed; the duration of surgery decreased by 2 minutes.

Conclusions: In our study, the introduction of FELD as a safe, quick procedure for the treatment of lumbar disc herniations can yield significant gains in patient-reported outcome measurements and pain reduction. The rate of recurrence and complications is comparable to that of standard surgery.