Transabdominal percutaneous L5 S1 lumbar discectomy: interventional technique, early results, and complications

PURPOSE: Anterior approaches to the lumbosacral spine have become increasingly common in spine surgery, but transabdominal percutaneous lumbar discectomy (TPLD) is challenging. This study describes TPLD and evaluates safety and early clinical results in the management of L5-S1 disc herniation. MATERIALS AND METHODS: Between October 2001 and October 2006, 58 consecutive patients with L5-S1 disc herniations were treated with TPLD of the L5-S1 discs, and nine of the patients with L4-L5 disc herniations were treated with posterolateral percutaneous lumbar discectomy (PPLD) soon after TPLD. The patients were divided into two groups according the operator who performed the procedures. The patients were evaluated with a visual analog scale (VAS) and the Oswestry Disability Index (ODI) at 5 years of follow-up. Logistic regression was used to analyze significant risk factors for complications. RESULTS: Mean hospital stay was 6.38 days +/- 8.48. VAS scores for leg pain and ODI scores showed significant improvement at last follow-up. All patients showed favorable results with no recurrent herniations. Major and minor complications occurred in eight (13.79%) and seven cases (12.06%), respectively, during and after the procedure. Major complications occurred in seven patients treated by operator A and one treated by operator B, a significant difference between operators (P = .044). Multivariate analysis revealed that only bowel preparation remained a significant predictor of complications (P = .040). CONCLUSION: TPLD was a safe and effective procedure for the removal of disc herniations at the L5-S1 level when total bowel preparation was performed.